**11.4. Positron emission tomography and fusion imaging**

There is interest also in nuclear molecular techniques, in particular 18F-fluorodeoxyglucose (FDG) PET/CT or PET/CTA, as a complimentary modality to echocardiography, especially when TEE is negative in the very early stages of infection and clinical suspicion remains high [136, 137]. 18F-FDG is taken up avidly by leukocytes and therefore identifies regions of inflammation. The CT scan provides complimentary anatomical information. The use of PET/ CT has been shown to substantially improve the sensitivity and thus diagnostic utility of the modified Duke criteria for diagnosis of both prosthetic valve endocarditis and cardiac devicerelated infections [138].
