Impact of Brain MRI on the Diagnosis of Infective Endocarditis and Treatment Decisions: Systematic Review and Meta-Analysis

Ahn, Yura; Joo, Leehi; Suh, Chong Hyun; Kim, Seongken; Shim, Woo Hyun; Kim, Sang Joon; Lee, Seung‐Ah

doi:10.2214/ajr.21.26896

Cited by 10 publications

(10 citation statements)

References 52 publications

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“…In addition, a recent study concluded that brain MRI was closely related to abnormalities that affect diagnostic or therapeutic plans in patients with infective endocarditis and emphasized the potential role of screening brain MRI regardless of neurologic symptoms. Therefore, our results are in line with these guidelines 10 , 11 , 25 and the current studies 28 , extending evidence for performing brain MRI in patients with suspected left-sided infective endocarditis regardless of neurological symptoms.…”

Section: Discussionsupporting

confidence: 91%

Detection rate of brain MR and MR angiography for neuroimaging abnormality in patients with newly diagnosed left-sided infective endocarditis

Kim,

Suh,

Kim

et al. 2023

Sci Rep

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We aimed to investigate the detection rate of brain MR and MR angiography for neuroimaging abnormality in newly diagnosed left-sided infective endocarditis patients with/without neurological symptoms. This retrospective study included consecutive patients with definite or possible left-sided infective endocarditis according to the modified Duke criteria who underwent brain MRI and MR angiography between March 2015 and October 2020. The detection rate for neuroimaging abnormality on MRI was defined as the number of patients with positive brain MRI findings divided by the number of patients with left-sided infective endocarditis. Positive imaging findings included acute ischemic lesions, cerebral microbleeds, hemorrhagic lesions, and infectious aneurysms. In addition, aneurysm rupture rate and median period to aneurysm rupture were evaluated on follow-up studies. A total 115 patients (mean age: 55 years ± 19; 65 men) were included. The detection rate for neuroimaging abnormality was 77% (89/115). The detection rate in patients without neurological symptoms was 70% (56/80). Acute ischemic lesions, cerebral microbleeds, and hemorrhagic lesions including superficial siderosis and intracranial hemorrhage were detected on MRI in 56% (64/115), 57% (66/115), and 20% (23/115) of patients, respectively. In particular, infectious aneurysms were detected on MR angiography in 3% of patients (4/115), but MR angiography in 5 patients (4.3%) was insignificant for infectious aneurysm, which were detected using CT angiography (n = 3) and digital subtraction angiography (n = 2) during follow-up. Among the 9 infectious aneurysm patients, aneurysm rupture occurred in 4 (44%), with a median period of aneurysm rupture of 5 days. The detection rate of brain MRI for neuroimaging abnormality in newly diagnosed left-sided infective endocarditis patients was high (77%), even without neurological symptoms (70%).

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Section: Discussionsupporting

confidence: 91%

Detection rate of brain MR and MR angiography for neuroimaging abnormality in patients with newly diagnosed left-sided infective endocarditis

Kim,

Suh,

Kim

et al. 2023

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…In addition, a recent study concluded that brain MRI was closely related to abnormalities that affect diagnostic or therapeutic plans in patients with infective endocarditis and emphasized the potential role of screening brain MRI regardless of neurologic symptoms. Therefore, our results are in line with these guidelines 10,11,19 and the current studies 22 , extending evidence for performing brain MRI in patients with suspected left-sided infective endocarditis regardless of neurological symptoms.…”

Section: Discussionsupporting

confidence: 91%

Detection rate of brain MR and MR angiography for neuroimaging abnormality in patients with newly diagnosed left-sided infective endocarditis

Kim

Suh

Kim

et al. 2023

Preprint

Self Cite

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We aimed to investigate the detection rate of brain MR and MR angiography for neuroimaging abnormality in newly diagnosed left-sided infective endocarditis patients with/without neurological symptoms. This retrospective study included consecutive patients with definite or possible left-sided infective endocarditis according to the modified Duke criteria who underwent brain MRI and MR angiography between March 2015 and October 2020. The detection rate for neuroimaging abnormality on MRI was defined as the number of patients with positive brain MRI findings divided by the number of patients with left-sided infective endocarditis. Positive imaging findings included acute ischemic lesions, cerebral microbleeds, hemorrhagic lesions, and mycotic aneurysms. In addition, aneurysm rupture rate and median period to aneurysm rupture were evaluated on follow-up studies. A total 115 patients (mean age: 55 years ± 19; 65 men) were included. The detection rate for neuroimaging abnormality was 77% (89/115). The detection rate in patients without neurological symptoms was 70% (56/80). Acute ischemic lesions, cerebral microbleeds, and hemorrhagic lesions were detected on MRI in 56% (64/115), 57% (66/115), and 20% (23/115) of patients, respectively. In particular, mycotic aneurysms were detected on MR angiography in 3% of patients (4/115), but MR angiography in 5 patients (4.3%) was insignificant for mycotic aneurysm. Among the 9 mycotic aneurysm patients, aneurysm rupture occurred in 4 (44%), with a median period of aneurysm rupture of 5 days. The detection rate of brain MRI for neuroimaging abnormality in newly diagnosed left-sided infective endocarditis patients was high, even without neurological symptoms.

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“…one-fourth of patients and intracranial mycotic aneurysms occurring in less than 10% of patients. 43 DWI may help differentiate acute cardioembolism from infective endocarditis from nonbacterial thrombotic endocarditis. One large, single-center study found that all patients (14/14) with nonbacterial thrombotic endocarditis had numerous <10 mm, 10 mm to 30 mm, and >30 mm lesions in multiple territories, whereas patients with infective endocarditis showed different patterns, including having a single lesion, a territorial infarction, or disseminated punctate lesions.…”

Section: Infectious Causes Of Strokementioning

confidence: 99%

“…Suspicion for infective endocarditis should be raised if C-reactive protein levels are higher than 10 mg/L 40 . In most patients with known or suspected infective endocarditis, acute ischemic lesions and cerebral microbleeds are seen on brain MRI, with other hemorrhagic lesions seen in about one-fourth of patients and intracranial mycotic aneurysms occurring in less than 10% of patients 43 . DWI may help differentiate acute cardioembolism from infective endocarditis from nonbacterial thrombotic endocarditis.…”

Section: Infectious Causes Of Strokementioning

confidence: 99%

Diagnostic Evaluation of Stroke Etiology

Meschia¹

2023

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVEPrecise therapies require precise diagnoses. This article provides an evidence-based approach to confirming the diagnosis of ischemic stroke, characterizing comorbidities that provide insights into the pathophysiologic mechanisms of stroke, and identifying targets for treatment to optimize the prevention of recurrent stroke.LATEST DEVELOPMENTSIdentifying the presence of patent foramen ovale, intermittent atrial fibrillation, and unstable plaque is now routinely included in an increasingly nuanced workup in patients with stroke, even as ongoing trials seek to clarify the best approaches for treating these and other comorbidities. Multicenter trials have demonstrated the therapeutic utility of patent foramen ovale closure in select patients younger than age 60 years. Insertable cardiac monitors detect atrial fibrillation lasting more than 30 seconds in about one in ten patients monitored for 12 months following a stroke. MRI of carotid plaque can detect unstable plaque at risk of being a source of cerebral embolism.ESSENTIAL POINTSTo optimize the prevention of recurrent stroke, it is important to consider pathologies of intracranial and extracranial blood vessels and of cardiac structure and rhythm as well as other inherited or systemic causes of stroke. Some aspects of the stroke workup should be done routinely, while other components will depend on the clinical circumstances and preliminary testing results.

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Impact of Brain MRI on the Diagnosis of Infective Endocarditis and Treatment Decisions: Systematic Review and Meta-Analysis

Cited by 10 publications

References 52 publications

Detection rate of brain MR and MR angiography for neuroimaging abnormality in patients with newly diagnosed left-sided infective endocarditis

Detection rate of brain MR and MR angiography for neuroimaging abnormality in patients with newly diagnosed left-sided infective endocarditis

Detection rate of brain MR and MR angiography for neuroimaging abnormality in patients with newly diagnosed left-sided infective endocarditis

Diagnostic Evaluation of Stroke Etiology

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