Expanding utility of cardiac computed tomography in infective endocarditis: A contemporary review

Table 1 Comparison of cardiac computed tomography vs transesophageal echocardiography findings in infective endocarditis[15,30]

	CCT	TEE
Vegetation	An irregular mass or thickening associated with the endocardium, native valve or prosthetic valve with low to intermediate attenuation	Mobile or non-mobile intracardiac mass on valve or other endocardial structures, including on implanted intracardiac material
Pseudoaneurysm	Perivalvular collection of contrast enhanced material usually adjacent to a valve with a visible direct communication	Abnormal perivalvular echo-free space with color-Doppler flow showing connection with the cardiovascular lumen
Abscess	Usually perivalvular collection of low attenuation material. Often has a thick layer of tissue in the wall of the collection that enhances with contrast	Usually perivalvular collection that can have an echodense or echolucent appearance without a communication to a lumen
Dehiscence of a prosthetic valve	Prosthetic valve misalignment with a tissue defect between the annulus and prosthesis	Evidence of excessive motion of a prosthetic valve. Occasionally, it is possible to see a defect between annulus and prosthesis and/or evidence of paravalvular leak on Doppler assessment
Perforation	Leaflet tissue defect that can be observed in two different views	Defect in a valve leaflet that may be seen visually as an interruption of tissue or by color flow across the defect
Fistula	An abnormal communication between two cardiac chambers that is contrast filled	An abnormal connection two neighboring lumen detected by color Doppler flow

CCT: Cardiac computed tomography; TEE: Transesophageal echocardiography.

Table 2 Strengths and limitations of various imaging modalities for assessing infective endocarditis

Modality	CCT	TTE	TEE	PET/CT
Strengths	Ability to image the entire thorax; Improved detection of perivalvular complications; CAD Assessment; Pre-Operative planning; Detection of extra-cardiac emboli	Good Spatial resolution; Availability and portable; Low cost; Lack of radiation; Lack of contrast; Chamber quantification; Assess hemodynamics	Improved spatial and temporal resolution over TTE; Availability and low cost; Lack of radiation; Lack of contrast; Better sensitivity than TTE in PVE; Assess Hemodynamics	Improved detection of perivalvular complications; Improved diagnostic accuarcy in PVE detection of embolic events
Weaknesses	Higher cost; Radiation exposure; Nephrotoxicity; Lower sensitivity for small vegetations and leaflet perforation; Availability may be limited	Limited value in PVE; No tissue characterization; Low sensitivity for peri-valvular complications	No tissue characterization; May miss some peri-valvular complications; Invasive procedure requiring sedation (cannot be performed in some patients with esophageal issues)	Limited availability; Higher cost; Radiation exposure

CCT: Cardiac computed tomography; TEE: Transesophageal echocardiography; TTE: Transthoracic echocardiography; PET: Positron emission tomography; PVE: Prosthetic valve endocarditis; CAD: Coronary artery disease.