Brain magnetic resonance findings in infective endocarditis with neurological complications

Azuma, Asako; Toyoda, Keiko; O’uchi, Toshihiro

doi:10.1007/s11604-008-0308-x

Cited by 14 publications

(7 citation statements)

References 28 publications

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“…MRI also demonstrated a neuroimaging embolism spectrum. Several years ago, Singhal et al, Barsic et al, and Okazaki et al noted the predominance of smaller lesions [ 14 – 16 ], which, instead, affect cortical and border zone arterial territories [ 17 ]. Similarly, Hess et al, on 109 prospective cases without neurologic symptoms, emphasized the frequency of acute ischemic lesions and of small infarcts widespread in watershed territories [ 7 ].…”

Section: Resultsmentioning

confidence: 99%

“…CT is not able to detect CMBs. This hypointense T2*-weighted MRI round or ovoid signal with a diameter <10 mm can be detected in elderly patients and, overall, in small-vessel disease such as arteriolosclerosis, chronic hypertension, amyloid angiopathy, as well as Alzheimer’s disease [ 13 , 17 ]. They notably have a strong specific IE association.…”

Section: Resultsmentioning

confidence: 99%

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Value of brain MRI in infective endocarditis: a narrative literature review

Champey

Pavèse

Bouvaist

et al. 2015

Eur J Clin Microbiol Infect Dis

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The nervous system is frequently involved in patients with infective endocarditis (IE). A systematic review of the literature was realized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). This study sought to systematically evaluate the published evidence of the contribution of brain magnetic resonance imaging (MRI) in IE. The aim was to identify studies presenting the incidence and type of MRI brain lesions in IE. Fifteen relevant studies were isolated using the Medline, Embase, and Cochrane databases. Most of them were observational studies with a small number of patients. MRI studies demonstrated a wide variety and high frequency of cerebral lesions, around 80 % of which were mostly clinically occult. This review shows MRI’s superiority compared to brain computed tomography (CT) for the diagnosis of neurologic complications. Recent developments of sensitive MRI sequences can detect microinfarction and cerebral microhemorrhages. However, the clinical significance of these microhemorrhages, also called cerebral microbleeds (CMBs), remains uncertain. Because some MRI neurological lesions are a distinctive IE feature, they can have a broader involvement in diagnosis and therapeutic decisions. Even if cerebral MRI offers new perspectives for better IE management, there is not enough scientific proof to recommend it in current guidelines. The literature remains incomplete regarding the impact of MRI on concerted decision-making. The long-term prognosis of CMBs has not been evaluated to date and requires further studies. Today, brain MRI can be used on a case-by-case basis based on a clinician’s appraisal.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Value of brain MRI in infective endocarditis: a narrative literature review

Champey

Pavèse

Bouvaist

et al. 2015

Eur J Clin Microbiol Infect Dis

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“…The frequency of detecting embolic lesions in the brain or spine may depend on the institute and country. The previous cohort from Japan showed that 93% of IE patients with neurological abnormality had intracranial abnormalities on head MRI (hemorrhage in three and abscess formation in three) [ 24 ]. The authors concluded that MRI should be promptly performed on IE patients.…”

Section: Discussionmentioning

confidence: 99%

A Gap of Patients with Infective Endocarditis between Clinical Trials and the Real World

Asai

Shibata

Hirai

et al. 2023

JCM

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Introduction: A randomized control trial (RCT) is considered to be the highest level in the Evidence-Based Medicine (EBM) pyramid. While EBM is essential to make a practical tool such as a prognostic guideline, it has been unclear how many patients in the real world can be eligible for a randomized control trial (RCT). Patients and method: This study was performed to clarify if there is a difference in patients’ profiles and clinical outcomes between the patients eligible and not eligible for any RCT. We reviewed all IE patients at our institute between 2007 and 2019. The patients were divided into two groups: those eligible for RCTs (RCT appropriate group) and those who were not (RCT inappropriate group). Exclusion criteria for clinical trials were set based on previous clinical trials. Results: A total of 66 patients were enrolled in the study. The median age was 70 years (range 18 to 87 years), and 46 (70%) were male. Seventeen (26%) of the patients were eligible for RCTs. Comparing the two groups, patients in the RCT appropriate group were younger and had fewer comorbidities. The disease severity was milder in the RCT appropriate groups than in the RCT inappropriate groups. Patients in the RCT appropriate group showed significantly longer overall survival times than those in the RCT inappropriate group (Log-Rank test, p < 0.001). Conclusions: We found a significant gap in patients’ characteristics and clinical outcomes between the groups. Physicians should be aware that RCT can never reflect the real-world population.

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“…Hypointense signal spots on T2*-weighted MRI are also observed in chronic hypertension, changes of an arteriosclerotic nature, and amyloid angiopathy. 21, 22 In a crosssectional study of 1,965 elderly subjects in Framingham, 78% of the patients with hypointense signal spots had hypertension, and the prevalence of patients with hypointense signal spots increased with age. 23 In our study, only 41% patients with hypointense signal spots had hypertension, and hypointense signal spots appeared in patients with regardless of age.…”

Section: Funding Sourcesmentioning

confidence: 99%