Multimodality Imaging in Infective Endocarditis (IE)
đź“Ť Part 1: Imaging for Diagnosis of Infective Endocarditis
Echocardiography
- TTE is the first-line imaging test (Class IB).
- If positive or inconclusive, follow with TEE (Class IB).
- Negative results should be repeated in 5–7 days if clinical suspicion remains.
Cardiac CTA
- Used when TTE/TEE is unclear in native or prosthetic valve IE.
- Detects valvular lesions, abscesses, and periprosthetic complications (Class IB).
[18F] FDG-PET/CT
- Detects metabolically active areas in prosthetic valve IE not seen on echo (Class IB).
- Helpful in CIED-related IE diagnosis (Class IIa B).
SPECT/CT
- Consider when high clinical suspicion persists and TTE/TEE or PET/CT is inconclusive or unavailable (Class IIa C).
đź“Ť Part 2: Imaging for Management and Monitoring of Infective Endocarditis
Echocardiography
- TEE is recommended when transitioning from IV to PO antibiotics (Class IB).
- Intraoperative TEE or completion imaging if not a surgical candidate (Class IC).
- Follow-up imaging up to 12 months post-treatment (Class IB).
Cardiac CTA
- Useful for pre-op coronary assessment in patients with aortic valve vegetations and high CAD risk (Class IB).
[18F] FDG-PET/CT
- Whole-body imaging can identify peripheral emboli or add diagnostic criteria (Class IB).
- Aids preoperative planning in prosthetic or complicated IE (Class IIa C).
SPECT/CT
- May help monitor resolution and detect complications in other organs (Class IIb–III C).
🧠Takeaway:
These 2023 ESC guideline-based imaging strategies emphasize a team-based, multimodal approach to diagnosis and follow-up of infective endocarditis—especially in complex or prosthetic valve cases.
Created by: @gmvasilakis
Edited by: @AmitGoyalMD
Graphics by: @CardioNerds
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