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Cerebral microbleeds predict infectious intracranial aneurysm in infective endocarditis

S-M Cho1,2, R J Marquardt1, C J Rice1

  • 1Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.

European Journal of Neurology
|April 1, 2018
PubMed
Abstract

Insights

Magnetic resonance imaging (MRI) features can predict infectious intracranial aneurysms (IIA) in infective endocarditis (IE) patients. Absence of MRI hemorrhages may rule out the need for digital subtraction angiography (DSA).

Area of Science:

  • Neurology
  • Radiology
  • Infectious Diseases

Background:

  • Infective endocarditis (IE) can lead to infectious intracranial aneurysms (IIA).
  • Cerebral microbleeds and susceptibility-weighted imaging (SWI) lesions on MRI are potential indicators of IIA.
  • Accurate identification of IIA is crucial for guiding invasive diagnostic procedures like digital subtraction angiography (DSA).

Purpose of the Study:

  • To validate specific MRI features as predictors of IIA in patients with IE.
  • To refine criteria for selecting patients who would benefit most from DSA.

Main Methods:

  • Retrospective analysis of two cohorts of IE patients who underwent both MRI and DSA.
  • Derivation cohort (n=62) and validation cohort (n=129) from a single tertiary referral center.
  • Evaluation of MRI findings including contrast enhancement, microbleeds, SWI lesions, and overall hemorrhages.

Main Results:

  • IIAs were present in 16% of the derivation cohort and 15% of the validation cohort.
  • MRI predictors for IIA included contrast enhancement with microbleeds, microbleeds >5 mm or sulcal SWI lesions, and any MRI hemorrhages.
  • Sensitivities in the validation cohort were 47%, 68%, and 94% for the respective predictors, with specificities of 87%, 75%, and 27%.

Conclusions:

  • Specific MRI findings demonstrate potential in predicting IIA in IE patients.
  • The absence of MRI-detected hemorrhages may suggest that DSA is not necessary.
  • These findings can help optimize the use of DSA in the management of IE patients.
Keywords:
cerebral angiographyinfectious intracranial aneurysminfective endocarditismagnetic resonance imagingmicrobleedssusceptibility-weighted imaging

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