Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study.

Duval X; Iung B; Klein I; Brochet E; Thabut G; Arnoult F; Lepage L; Laissy JP; Wolff M; Leport C; IMAGE (Resonance Magnetic Imaging at the Acute Phase of Endocarditis) Study Group; Duval, Xavier; Iung, Bernard; Klein, Isabelle; Brochet, Eric; Thabut, Gabriel; Arnoult, Florence; Lepage, Laurent; Laissy, Jean-Pierre; Wolff, Michel

<bold>Background: </bold>Neurologic complications of endocarditis can influence diagnosis, therapeutic plans, and prognosis.<bold>Objective: </bold>To describe how early cerebral magnetic resonance imaging (MRI) affects the diagnosis and management of endocarditis in hospitalized adults.<bold>Design: </bold>Single-center prospective study between June 2005 and October 2008. (ClinicalTrials.gov registration number: NCT00144885)<bold>Setting: </bold>Tertiary care university hospital in France.<bold>Patients: </bold>130 patients with endocarditis.<bold>Intervention: </bold>Cerebral MRI with angiography performed up to 7 days after admission and before any surgical intervention.<bold>Measurements: </bold>2 experts jointly established the endocarditis diagnostic classification (according to Duke-modified criteria) and therapeutic plans just before and after MRI and then compared them.<bold>Results: </bold>Endocarditis was initially classified as definite in 77 patients and possible in 50 and was excluded in 3. Sixteen patients (12%) had acute neurologic symptoms. Cerebral lesions were detected by MRI in 106 patients (82% [95% CI, 75% to 89%]), including ischemic lesions in 68, microhemorrhages in 74, and silent aneurysms in 10. Solely on the basis of MRI results and excluding microhemorrhages, diagnostic classification of 17 of 53 (32%) cases of nondefinite endocarditis was upgraded to either definite (14 patients) or possible (3 patients). Endocarditis therapeutic plans were modified for 24 (18%) of the 130 patients, including surgical plan modifications for 18 (14%). Overall, early MRI led to modifications of diagnosis or therapeutic plan in 36 patients (28% [CI, 20% to 36%]).<bold>Limitation: </bold>Investigators did not assess whether the MRI-related changes in diagnosis and therapeutic plans improved patient outcomes or led to unnecessary procedures and increased costs.<bold>Conclusion: </bold>Cerebral lesions were identified by MRI in many patients with endocarditis but no neurologic symptoms. The MRI findings affected both diagnostic classifications and clinical management plans.<bold>Primary Funding Source: </bold>French Ministry of Health.

Annals of Internal Medicine, 2010, Vol 152, Issue 8, p497

0003-4819

Academic Journal

10.7326/0003-4819-152-8-201004200-00006