Leonardo Brugiatelli, F Patani, Carla Lofiego, Martina Benedetti, Irene Capodaglio, Pongetti Giulia, Matteo Francioni, Emilio A Paolini, Nazziconi Marco, K Maurizi, F Giulia, Massari Arianna, Luciani Simone, Anselmi Benedetta, Gatti Chiara, Schicchi Nicolò, Marco Fogante, T Giovanni, Dello Russo Antonio, Di Eusanio Marco, Marco Marini, Fabio Vagnarelli
Infective endocarditis (IE) is a life-threatening condition with a rising incidence, demanding rapid and precise diagnosis. While echocardiography remains the cornerstone of initial evaluation, its limitations in complex cases-such as those involving prosthetic valves or cardiac devices-are well-known. This review synthesizes current evidence and guidelines to outline a practical, multimodality imaging approach for IE. We emphasize that integrating advanced techniques like cardiac computed tomography (CT) and [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) early in the diagnostic pathway, particularly in high-risk scenarios, significantly enhances diagnostic certainty, guides therapeutic decisions, and improves patient outcomes. A tailored imaging strategy, driven by clinical presentation and integrated within a multidisciplinary endocarditis team, is paramount for modern IE management.