■ Paravalvar complications, including aortic abscess34,35 ■ Intrastent vegetations ■ PTE ■ Systemic peripheral thromboembolism, including cerebral ■ Subarachnoid hemorrhage in ruptured mycotic aneurysms It is reasonable to screen patients with right-sided IE for possible PTE prior to operation Serial CT images show progression of disease and are an invaluable tool to guide management and are becoming more widely used There are currently no large comprehensive studies for the use of CT in pediatric IE, and this is a field of future interest Positron Emission Tomography–Computed Tomography Positron emission tomography (PET)/CT is another new imaging strategy included in the 2015 European Society of Cardiology (ESC) IE diagnostic criteria.1 It is a nuclear imaging method that uses 18F-fluorodeoxyglucose (18FFDG) and capitalizes on the fact that infectious and inflammatory foci are metabolically active and have higher uptake of 18F-FDG The addition of 18FFDG PET/CT as a major criterion increases the sensitivity of the modified Duke score from 70% up to 97% for prosthetic valve endocarditis (PVE) and implantable cardiac electrical device–related IE (ICED-IE).38 PET/CT has great added value for diagnosing IE in the case of unconvincing outcome of the rest of the imaging in suspected IE, especially in prosthetic valve IE or cardiac device–related IE The role of PET/CT for the previously mentioned indications has been characterized36,37 and confirmed in recent larger studies.38–41 The role of PET/CT in pediatric cardiac patients and patients with congenital heart defects in general has recently been reviewed.42 There are currently no large comprehensive studies for the use of PET/CT in pediatric IE, and this is a field of future interest Brain Imaging Patients with IE and neurologic symptoms should undergo brain imaging, magnetic resonance imaging (MRI), or, if not possible, CT Brain MRI has great significance for visualizing the cerebral complications of IE.43 It is reasonable to screen patients with left-sided IE for possible brain involvement prior to operation.7 Serial brain imaging is excellent to show whether there is an increasing number of mycotic aneurysms and other changes that will indicate early surgery Diagnosis The diagnosis of IE still uses the modified Duke criteria.11 Under the current revision, following the advances in imaging, the ESC 2015 guidelines have added the positive CT and the PET/CT to the major criteria under the list of positive imaging modalities The currently used version of the diagnostic criteria with revisions and recent amendments is shown in Table 56.2 Table 56.2 Revised Duke Diagnostic Criteria for Infective Endocarditis With Amendments Major Criteria Blood culture (BC) positive for IE ■ Typical microorganism consistent with IE from 2 separate BC: ■ Viridans-group streptococci ■ Streptococcus bovis ■ HACEK group ■ Staphylococcus aureus ■ Community-acquired Enterococci, in the absence of a primary focus ■ Microorganisms consistent with IE from persistently positive BC defined as: ■ Two positive BC of blood samples drawn >12 hours apart, or ■ All of 3 or a majority of 4 separate BC of blood (with first and last sample drawn 1 hour apart) ■ Single positive BC for Coxiella burnetii of phase I IgG antibody titer >1 : 800 Imaging positive for IE ■ Positive echocardiogram: ■ Vegetation (oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation) ■ Valvar perforation/aneurysm, chordal rupture (new valvar regurgitation) ■ Abscess, pseudoaneurysm, intracardiac fistula ■ New partial dehiscence of prosthetic valve ■ Positive cardiac CT: ■ Paravalvar lesions, abscess ■ Intraluminal filling defect ■ Positive nuclear imaging: ■ Abnormal activity detected on 18F-FDG PET/CT or radiolabeled leukocytes SPECT around the site of prosthetic valve (only if the prosthesis was Minor Criteria Predisposing factor: known cardiac lesion, recreational drug injection Fever >38°C Evidence of embolism: pulmonary thromboembolism, peripheral and cerebral embolism, mycotic aneurysms, Janeway lesions, conjunctival hemorrhages Immunologic problems: glomerulonephritis, Osler nodes Positive blood culture (that does not meet a major criterion) ...general has recently been reviewed.42 There are currently no large comprehensive studies for the use of PET/CT in pediatric IE, and this is a field of future interest Brain Imaging Patients with IE and neurologic symptoms should undergo brain imaging,