Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis: A contemporary narrative review

Table 1 Comparison between different imaging modalities in the evaluation of prosthetic valve endocarditis

Modality	Strengths	Weaknesses	Sensitivity	Specificity
Echocardiography	Available, convenient, no radiation exposure, hemodynamic data, high temporal resolution.	Operator- and imaging window-dependent, affected by prosthesis-related artifacts.	TTE: 17%–36%; TEE: 82%–96%	TTE: 86%[39,40]; TEE: 94%[39,40,45]
Cardiac CT	Spatial resolution, defining paravalvular complications, delineating coronary-aorta anatomy, preoperative planning.	Radiation exposure, contrast exposure limits use in advanced CKD.	88%–97%	95%[47,48,50]
Cardiac MRI	Characterizing paravalvular complications, depicts inflammatory changes, assess the degree of intra-cardiac shunting.	Limited data, lower spatial resolution, incompatibility with some cardiac devices. Limited clinical applicability.	Limited data	Limited data
18F-FDG PET/CT	Excellent diagnostic role in PVE, detection of metastatic infection foci.	Availability, cost, requires special pre-test preparation, expertise, radiation exposure.	73%–97%	80%–94%[60-62]

TTE: Transthoracic echocardiography; TEE: Transesophageal echocardiography; CTA: Computed tomographic angiography; MRI: Magnetic resonance imaging; PET/CT: Positron emission tomography/computer tomography.