CT also allows evaluation of the motion of mechanical valve occluders and provides visualization of throm- bus or infective material limiting valve occluder motion. Additional imaging modalities, such as cardiac valvular fluoroscopy, can be an adjunct to other clinical and imaging information to detect the presence of obstructive disease in mechanical prosthetic valves affected by IE.61,64 68 13. Diagnosis of IE can still be a vexing under- taking. It has been shown that the use of F-fluorodeoxyglucose PET/CT at the initial presentation of patients with suspected pros- thetic valve endocarditis increases the diagnos- tic capability of the Modified Duke Criteria. The inclusion of abnormal 18 F-fluorodeoxyglucose cardiac uptake as a major criterion addition to the Modified Duke Criteria enabled a recatego- rization of 76% of patients with prosthetic valve endocarditis initially classified as possible IE on admission to the hospital to definite IE. This tool must be used in centers with great experi- ence with the technology, as this imaging tech- nique may also be prone to false-positive results because of sterile inflammation in implanted prosthetic valves. 18 F-fluorodeoxyglucose PET/ CT may also be considered a complementary diagnostic tool for some patients with suspected native valve endocarditis.69 71 14. Because the frequency of IE among patients with S. aureus bacteremia is reported to be approxi- mately 30%, with many cases not being clinically suspected, TEE may be considered in the setting of S. aureus bacteremia to rule out IE. Even in S. aureus bacteremia from a known extracardiac source, such as an infected joint or joint prosthe- sis, TEE might be considered, given known cases of seeding of valve tissue in this type of setting. 