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Asbjørn Mathias Scholtens et al. JIMG 2016;9:1462-1465 18F-FDG-PET/CT in PHV Endocarditis: How Much Is Too Much? PET/CT images of the valvular plane in 3 different patients with a mechanical prosthetic heart valve (PHV) (A to C) and a patient with a Carpentier-Edwards bioprosthesis (Edwards Lifesciences, Irvine, California), with maximum standard uptake values (SUVmax) and target-to-background ratios (TBR) (SUVmax PHV divided by SUVmean aortic blood pool). (A) Images show no significant 18F-FDG uptake surrounding the PHV in a patient without endocarditis. (B) Images show intense uptake of 18F-FDG in surgically confirmed infection of the aortic root surrounding the PHV ring. (C) Images show mild to moderate uptake of 18F-FDG surrounding and confined to the PHV ring, in a patient confirmed by follow-up to have no PHV endocarditis. (D) Images show mild, symmetrical 18F-FDG uptake at or near the struts to which the leaflets are fastened (shown in detail in the first CT–maximum intensity projection image), typical of this type of prosthesis. A mild to moderate amount of 18F-FDG uptake around a PHV is a normal variant, possibly due to a mild foreign body reaction or strain on the aortic wall. Abbreviations as in Figure 1. Asbjørn Mathias Scholtens et al. JIMG 2016;9:1462-1465 American College of Cardiology Foundation