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MRI Presentation of Infectious Intracranial Aneurysms in Infective Endocarditis

Ibrahim Migdady1, Cory J Rice1, Catherine Hassett1

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

Neurocritical Care
|December 7, 2018
PubMed
Abstract

Insights

Magnetic resonance imaging (MRI) can reveal specific features of infectious intracranial aneurysms (IIAs) in patients with infective endocarditis (IE). Susceptibility-weighted imaging (SWI) lesions and contrast enhancement are common MRI findings associated with IIAs.

Area of Science:

  • Neurology
  • Radiology
  • Infectious Diseases

Background:

  • Infectious intracranial aneurysms (IIAs) are a serious complication of infective endocarditis (IE).
  • The radiographic appearance of IIAs on brain MRI can be variable.
  • Accurate identification of IIAs on MRI is crucial for timely treatment.

Purpose of the Study:

  • To describe the specific MRI features of IIAs in patients with IE.
  • To correlate MRI findings with digital subtraction angiography (DSA) results.
  • To identify common MRI presentations associated with IIAs.

Main Methods:

  • Retrospective review of patients with active IE and DSA from 2011-2016.
  • Analysis of pre-treatment brain MRI scans, including SWI, DWI, and T1-weighted imaging with and without contrast.
  • Comparison of MRI findings with DSA for 33 IIAs in 28 patients.

Main Results:

  • Of 732 IE patients, 53 (7%) had IIAs; 28 had evaluable pre-treatment MRI.
  • Common MRI findings included SWI lesions with contrast enhancement (36%), cerebral microbleeds (21%), and abscesses (6%).
  • Hemorrhage (intraparenchymal and subarachnoid) and ischemic stroke were also observed in the vicinity of IIAs.

Conclusions:

  • Susceptibility-weighted imaging (SWI) lesions and contrast enhancement are the most frequent MRI findings associated with IIAs.
  • MRI can effectively visualize IIAs and associated complications in patients with IE.
  • These findings aid in the diagnosis and management of IIAs.
Keywords:
Cerebral angiographyInfectious intracranial aneurysmsInfective endocarditisMRI

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