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Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging MRI
Published on: December 16, 2021
Prediction of early postoperative cerebral hemorrhage in infective endocarditis patients using magnetic resonance
Suguru Ohira1, Kiyoshi Doi, Hidetake Kawajiri
1Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan, suguru19820411@yahoo.co.jp.
Objective:
To evaluate the relationship between preoperative magnetic resonance imaging (MRI) findings and the occurrence of postoperative intracranial hemorrhage (ICH) in infective endocarditis (IE) patients.
Methods:
Between 2002 and 2012, 30 IE patients required surgical intervention. Four patients developed and 26 patients did not develop postoperative ICH. All patients underwent preoperative brain MRI. The presence of acute brain infarction was detected by diffusion-weighted imaging (DWI), and cerebral microbleeds were detected by T2*-weighted imaging.
Results:
Two ICH(+) patients died of stroke. Preoperative patient characteristics and operative results were not significantly different. Regarding MRI findings, the presence of cerebral microbleeds or acute brain infarction alone was not significantly different between the two groups (100 vs. 29.6 %, p = 0.07; 75.0 vs. 38.5 %, p = 0.37, respectively). The concurrent presence of cerebral microbleeds and acute brain infarction was significantly correlated with the development of major ICH (75 vs. 14.8 %, p = 0.04). In multiple logistic regression analyses, the concurrent presence of cerebral microbleeds and acute brain infarction on MRI was an independent predictor of major postoperative ICH (p = 0.03, odds ratio 16.5, 95 % confidence interval 1.35-201.3).
Conclusion:
The combination of T2*-weighted MRI and DWI may be useful to evaluate the risk of IE patients developing major postoperative cerebral bleeding.
Insights
Preoperative brain MRI showing both cerebral microbleeds and acute brain infarction significantly predicts major postoperative intracranial hemorrhage (ICH) in infective endocarditis (IE) patients undergoing surgery.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Infective endocarditis (IE) poses a significant risk for neurological complications, including intracranial hemorrhage (ICH).
- Predicting postoperative ICH in IE patients undergoing surgery is crucial for risk stratification and management.
Purpose of the Study:
- To investigate the association between preoperative magnetic resonance imaging (MRI) findings and the incidence of postoperative ICH in patients with IE.
Main Methods:
- A cohort of 30 IE patients who underwent surgery between 2002 and 2012 were analyzed.
- Preoperative brain MRI, including diffusion-weighted imaging (DWI) for acute brain infarction and T2*-weighted imaging for cerebral microbleeds, was performed on all patients.
- Patients were categorized based on the development of postoperative ICH.
Main Results:
- The concurrent presence of cerebral microbleeds and acute brain infarction on preoperative MRI was significantly associated with major postoperative ICH (75% vs. 14.8%, p=0.04).
- This combination of findings independently predicted major ICH (OR 16.5, p=0.03).
- Neither cerebral microbleeds nor acute brain infarction alone significantly predicted ICH.
Conclusions:
- Combined T2*-weighted MRI and DWI findings can identify IE patients at higher risk for major postoperative cerebral bleeding.
- This imaging approach may aid in preoperative risk assessment for neurosurgical interventions in IE patients.
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