Registry of the use of PET-CT in the diagnosis of infective endocarditis: indications and usefulness.
Bibliographic record
Abstract
Abstract Background Positron emission tomography and computed tomography (PET/CT) is a very sensitive tool for the diagnosis of infective endocarditis (IE), especially in patients with valve prostheses. Despite its high level of recommendation in the latest clinical practice guidelines, its application and usefulness in real life is still poorly studied. Purpose Our objective was to review the profile of patients prescribed PET/CT, as well as its impact on their management in a hospital with cardiovascular surgery that requires transfer of patients to another center for its performance. Methods Observational, retrospective, single-center, retrospective study in which we selected patients admitted between 2016-2023 with suspected or diagnosed IE and collected clinical, echocardiographic, and PET/CT data. Results From 188 patients, PET/CT was performed in only 14 patients (7.44%), with a median age of 67 years (RIQ 25), 71.4% being male. Infectious involvement was mostly on prosthetic valves (9; 64.3%), mainly late (6; 42.9%), with 3 biological, 5 mechanical and 1 TAVI, in addition to 2 device infections. The indication in native valves was for bicuspid aortic valve and suspected periannular complications. The indications for PET/CT included: diagnostic confirmation by inconclusive transesophageal echocardiography (TEE) in 6 patients (42.9%), extension of the TEE study to verify infectious activity in periannular complications in 4 patients (28.6%) and diagnosis of IE in devices in 4 patients (28.6%), without having been indicated in any patient to assess emboligenic lesions. The median number of days of antibiotic therapy until PET/CT was 14.5 days (RIQ 52). All but one of the PET/CT scans were positive for infective endocarditis, with a median SUVmax of 4.6. As a result of the PET/CT results, the therapeutic approach was modified in 5 patients (35.7%), with valve replacement surgery indicated in 4 patients and one electrode removal. The antibiotherapy regimen was not modified in the remaining patients. Conclusions Despite its high sensitivity for the diagnosis of IE and its high level of recommendation, PET/CT is underused in our setting, partly due to its low availability. New studies are needed to better define the profile of patients who really benefit from this technique because it implies a change in their clinical management.Indications and therapeutic approach
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".