*5.3.1. Vegetations*

During the 1980s and 1990s, with the introduction of monoplane TEE, a number of landmark studies were published comparing the diagnostic accuracy of TEE for identification of vegetations against the gold standard of surgery or pathological findings. Reported sensitivities and specificities of TEE for detection of left-sided vegetations ranged from 94 to 100% and 77 to 95% for native and prosthetic valves, respectively. Specificity was consistently high at >90% (**Table 1**).

A few studies compared monoplane, biplane, and multiplane TEE. Earlier work found marginally higher detection rates of vegetations and/or abscesses, but differences were minimal [82, 83]. Monoplane TEE not only underestimated vegetation size and extent but also was found to be less accurate at detecting small vegetations [83]. Contemporary studies using multiplane imaging report sensitivities >90% [68, 84]. Considering TEE imaging has always demonstrated high sensitivity and specificity for detection of vegetations, it is unclear if multiplane imaging has improved the diagnostic accuracy.

The reported sensitivity of 2D TEE for detection of vegetations in CDRIE ranges from 73 to 96% (**Table 4**) and is also superior over TTE for distinguishing site of attachment, whether valvular or on a lead.
