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CLINICAL RESEARCH: CARDIAC IMAGING

Multislice Computed Tomography in Infective Endocarditis

Comparison With Transesophageal Echocardiography and Intraoperative Findings

Gudrun M. Feuchtner, MD, PD^_*,_*, Paul Stolzmann, MD, Wolfgang Dichtl, MD, PhD, PD, Thomas Schertler, MD, Johannes Bonatti, MD, FECTS, Hans Scheffel, MD, Silvana Mueller, MD, André Plass, MD^||, Ludwig Mueller, MD, Thomas Bartel, MD, PD, Florian Wolf, MD^¶ and Hatem Alkadhi, MD, PD

^_* Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria
Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
^|| Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
^¶ Department of Radiology, Vienna Medical University, Vienna, Austria

Manuscript received October 1, 2007; revised manuscript received December 19, 2007, accepted January 6, 2008.

^_* Reprint requests and correspondence: Dr. Gudrun M. Feuchtner, Innsbruck Medical University, Department of Radiology II, Anichstrasse 35, A-6020 Innsbruck, Austria (Email: gudrun.feuchtner{at}i-med.ac.at).

Objectives: The aim of this study was to assess the value of multislice computed tomography (CT) for the assessment of valvular abnormalities in patients with infective endocarditis (IE) in comparison with transesophageal echocardiography (TEE) and intraoperative findings.

Background: Multislice CT has recently shown promising data regarding valvular imaging in a 4-dimensional fashion.

Methods: Thirty-seven consecutive patients with clinically suspected IE were examined with TEE and 64-slice CT or dual-source CT. Twenty-nine patients had definite IE and underwent surgery.

Results: The diagnostic performance of CT for the detection of evident valvular abnormalities for IE compared with TEE was: sensitivity 97%, specificity 88%, positive predictive value (PPV) 97%, and negative predictive value (NPV) 88% on a per-patient basis (n = 37; excellent intermodality agreement = 0.84). CT correctly identified 26 of 27 (96%) patients with valvular vegetations and 9 of 9 (100%) patients with abscesses/pseudoaneurysms compared with the intraoperative specimen. On a per-valve–based analysis, diagnostic accuracy for the detection of vegetations and abscesses/pseudoaneurysms compared with surgery was: sensitivity 96%, specificity 97%, PPV 96%, NPV 97%, and sensitivity 100%, specificity 100%, PPV 100%, NPV 100%, respectively, without significant differences as compared with TEE. Vegetation size measurements by CT correlated (r = 0.95; p <0.001) with TEE (mean 7.6 ± 5.6 mm). The mobility of vegetations was accurately diagnosed in 21 of 22 (96%) patients with CT, but all of 4 leaflet perforations (2 mm) were missed. CT provided more accurate anatomic information regarding perivalvular extent of abscess/pseudoaneurysms than TEE.

Conclusions: Multislice CT shows good results in detecting valvular abnormalities in IE and could be applied in pre-operative planning and exclusion of coronary artery disease before surgery.

Key Words: 64-slice computed tomography • CT • MSCT • valvular disease • infective endocarditis • cardiac surgery

Abbreviations and Acronyms   CI = confidence intervals   CT = computed tomography   IE = infective endocarditis   NPV = negative predictive value   PPV = positive predictive value   RCA = right coronary artery   TEE = transesophageal echocardiography   TTE = transthoracic echocardiography

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