Early Diagnosis of Infective Endocarditis by Brain T2*-Weighted Magnetic Resonance Imaging

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  • Fujimoto Takashi
    Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
  • Morofuji Yoichi
    Department of Neurosurgery, Nagasaki University School of Medicine
  • Matsunaga Yuki
    Department of Neurosurgery, Nagasaki University School of Medicine
  • Horie Nobutaka
    Department of Neurosurgery, Nagasaki University School of Medicine
  • Izumo Tsuyoshi
    Department of Neurosurgery, Nagasaki University School of Medicine
  • Tateishi Yohei
    Department of Neurology and Strokology, Nagasaki University School of Medicine
  • Morikawa Minoru
    Department of Radiology, Nagasaki University School of Medicine
  • Miura Takashi
    Department of Cardiovascular Surgery, Nagasaki University School of Medicine
  • Eishi Kiyoyuki
    Department of Cardiovascular Surgery, Nagasaki University School of Medicine
  • Matsuo Takayuki
    Department of Neurosurgery, Nagasaki University School of Medicine

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Abstract

<p>Background:Because infective endocarditis (IE) carries a high risk of morbidity and mortality, rapid diagnosis and effective treatment are essential to achieving a good patient outcome. However, the diagnosis of IE is often difficult in patients presenting with nonspecific clinical manifestations. An association between IE and hypointense signal spots on brain T2*-weighted magnetic resonance imaging (MRI) has been reported, but the clinical significance remains unclear.</p><p>Methods and Results:To assess the clinical importance of silent lesions in the brains of IE patients, hypointense signal spots detected on their brain T2*-weighted MRI scans were investigated in a retrospective review of 44 consecutive patients with definite or suspected IE evaluated by MRI between June 2006 and January 2014. Hypointense signal spots on T2*-weighted MRI were detected in 37 (84%) patients; of these, 21 (46%) had ischemic lesions, 10 (22%) had subarachnoid hemorrhage, 4 (9%) had intraparenchymal hemorrhage, and 4 (9%) had infectious aneurysm. The hypointense signal spots on T2*-weighted images were preferentially distributed in cortical areas.</p><p>Conclusions:T2*-weighted hypointense signal spots are highly frequent in patients with IE and their presence may be informative in the monitoring of IE-associated brain lesions, even those that are neurologically asymptomatic. The strong association between IE and T2*-weighted hypointense signal spots supports the need to consider additional criteria in the diagnosis of IE.</p>

Journal

  • Circulation Journal

    Circulation Journal 82 (2), 464-468, 2018

    The Japanese Circulation Society

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