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

BACKGROUND: Neurologic complications of endocarditis can influence diagnosis, therapeutic plans, and prognosis.

OBJECTIVE: To describe how early cerebral magnetic resonance imaging (MRI) affects the diagnosis and management of endocarditis in hospitalized adults.

DESIGN: Single-center prospective study between June 2005 and October 2008. ( registration number: NCT00144885)

SETTING: Tertiary care university hospital in France.

PATIENTS: 130 patients with endocarditis.

INTERVENTION: Cerebral MRI with angiography performed up to 7 days after admission and before any surgical intervention.

MEASUREMENTS: 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.

RESULTS: 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%]).

LIMITATION: 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.

CONCLUSION: 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.

PRIMARY FUNDING SOURCE: French Ministry of Health.

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