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Master Thesis

Early brain MRI interest in infective endocarditis clinical management: a prospective study

Abstract : Introduction: In Infective Endocarditis (IE), brain Magnetic Resonance Imaging (MRI) is helpful to diagnose clinically silent neurologic events, especially micro ischemic and micro haemorrhagic lesions. Brain MRI may be fitted in a complete imaging check-up including, at an early stage, chest abdomen, pelvis Computered Tomography (CT) and echocardiography for a thoroughly asymptomatic lesions mapping. Objective: We aimed to assess the usefulness of systematic early brain MRI in IE diagnosis and medico-surgical cares management. Methods: During one year, all patients admitted in one of the 3 hospitals participating and fulfilling Duke’s criteria for definite or possible IE, underwent cerebral MRI with angiography within the 7 days of IE-suspicion. To assess the MRI contribution, records were analyzed a posteriori by 8 panels of experts. For each case, one record with and one record without the MRI results, were randomly assigned to 2 panels who determined theoretical diagnosis and treatment. Inter-rater concordances were assessed through Cohen Kappa test. Results: Thirty-seven brain MRI were realized in a median time of 5 days after inclusion. MRI was pathological in 26 patients (70%) showing 62 % of micro ischemia and 58% of microbleeds. Experts advices were significantly concordant between the 2 evaluations with or without the MRI results. Diagnosis differed in 2 cases (5.4%) with an upgrading of diagnosis from possible to definite IE using MRI results. Discrepancies concerning therapeutic attitudes occurred in 8 cases (21.5%) including one change in the indication to operate, 3 modifications of timing of surgery namely 2 earlier and one postponed surgery with the MRI results and 1 disagreement over the choice of prosthesis. Changes concerned anticoagulation in 2 cases. Rifampicin was added to the antimicrobial therapy in 1 case. Conclusion: Because it does not seem to plenty affect diagnosis and medico-surgical cares; our results do not support the need for a systematic use of early brain MRI in IE. Further studies are necessary to clearly define if MRI is mandatory in IE management within a multidisciplinary approach; the better timing to realize it and the subset of patients in which it could be beneficial.
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Master Thesis
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Submitted on : Thursday, May 21, 2015 - 4:16:53 PM
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  • HAL Id : dumas-01154337, version 1

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Julia Champey. Early brain MRI interest in infective endocarditis clinical management: a prospective study. Human health and pathology. 2015. ⟨dumas-01154337⟩

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