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. (ClinicalTrials.govregistration 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.