Introduction
Research question and search strategy
Search performed in the following numerical order: |
#1 infectious endocarditis |
#2 infective endocarditis |
#3 magnetic resonance imaging |
#4 brain |
#5 cerebrovascular disorders |
#6 microbleeds |
#7 #1 OR #2 |
#8 #7 AND #3 |
#9 #7 AND #4 |
#10 #7 AND #5 |
#11 #8 AND #5 |
#12 #7 AND #6 |
#13 #8 AND #6 |
Results
Study selection and characteristics
Study | Study period | Inclusion criteria | Design of study | Number of participants | Mean age | Imaging protocol | Main results | MRI follow-up | Neurocognitive follow-up |
---|---|---|---|---|---|---|---|---|---|
Morofuji et al., 2010, Clinical Neurology and Neurosurgery, Japan [26] | 2006–2007 | IEa diagnosis according to modified Duke criteria | Retrospective monocentric | 11 | 54 | T2*- weighted MRIb protocol | 72.7 % of patients had MRIb abnormalities; 63.2 % of patients showed CMBsc; number of CMBsc increased in 14–28 days in five patients with multiple lesions | In the month after initial MRIb for seven patients | No |
Singhal et al., 2002, Stroke, USA [14] | 1993–2000 | Definite or possible IEa according to Duke criteria | Retrospective monocentric comparison of acute and recurrent ischemic stroke in IEa and NBTEd
| 35 (27 IE/9 NBTEd) | 53 | DWIe MRI in the second week after the onset of neurological symptoms | NBTEd patients uniformly had multiple widely distributed, small and large strokes, whereas IEa patients exhibited also other patterns, such as a single lesion, territorial lesion, disseminated punctate lesions; disseminated punctate lesions were related to clinical encephalopathy | In the month after initial MRIb for four IEa patients | No |
Hess et al., 2013, AJNR. American Journal of Neuroradiology, France [7] | 2005–2008 | Definite or possible IEa according to Duke criteria | Prospective monocentric | 109 | 59 | MRIb imaging within 7 days after inclusion GREf and DWIe sequences; double blinding interpretation | MRIb showed abnormalities in 71.5 % of patients; 37 % ischemic lesions; 57 % CMBsc; eight patients had acute hemorrhage, three had microabscesses, three had small cortical hemorrhage, three had mycotic aneurysm; 52.5 % of lesions had different ages; 62.5 % of ischemic lesions were multiple small infarcts disseminated in watershed territories; CMBsc were preferentially distributed in cortical areas; no significant relation was found between ischemia and CMBsc
| No | No |
Klein et al., 2009, Stroke, France [22] | 2005–2008 | Definite or possible IEa according to Duke criteria | Retrospective case–control study | 60 IEa matched with 120 controls | 62 | Cerebral MRIb within 7 days after admission; standardized protocol GREf and DWIe sequences; double blinding interpretation | CMBsc were more prevalent in IEa patients (57 %) than in control subjects [15 %; odds ratio (OR) 10.06]; the OR of IEa increased dramatically with the number of CMBs | No | No |
Goulenok et al., 2013, Cerebrovascular Diseases, France [1] | 2005–2007 | Probable or definite IEa according to modified Duke criteria and neurological complications | Prospective monocentric cohort study | 30 | 58 | Cerebral MRIb within 7 days after admission; MRIb comparison with non-contrast CTg (n = 5 ) and angio-CTg (n = 26); imaging review by a blinded neuroradiologist | MRIb findings: ischemia (n = 25), CMBsc(n = 17), mycotic aneurysm (n = 7), abscess (n = 6), subarachnoid hemorrhage (n = 5), vascular occlusion (n = 3), hemorrhagic lesion (n = 2); in 19/30 cases, neurologic symptoms were observed before IEa diagnosis; none of the 16 operated patients underwent postoperative worsening; MRIb was more sensitive than CTg in detecting both symptomatic (100 and 81 %, respectively) and silent cerebral lesions (50 and 23 %, respectively); therapeutic plans were modified according to the MRI results in 27 % of patients, including surgical plan in 20 % | No | No |
Iung et al., 2013, Stroke, France [20] | 2005–2008 | Definite or possible IEa according to Duke clinical criteria | Prospective monocentric cohort study | 120 | 61 | Cerebral MRIb within 7 days following admission | MRIb detected ischemic lesions in 53.3 % of patients and CMBsc in 60 % of patients; ischemic lesions were associated with vegetation length and Staphylococcus aureus; CMBsc were associated with no prior anticoagulant therapy and prosthetic IEa; vegetation length >4 mm identified ischemic lesions with 74.6 % sensitivity and 51.5 % specificity | ||
Cooper et al., 2009, Circulation, USA [9] | 2004–2007 | Definite IEa according to modified Duke criteria in patients in whom there was at least one left-side heart valve involvement on echocardiography | Prospective | 56 | 58 | Brain MRIb as soon as possible and before any surgical intervention; imaging review by a blinded neuroradiologist | 80 % acute brain embolization; 48 % subacute brain embolization; lower risk of mortality at 3 months with cardiac surgery; OR 0.1 (0.003–0.6), p = 0.008 | No | No |
Okazaki et al., 2013, Cerebrovascular Diseases, Japan [16] | 2004–2011 | Only definite left-side IEa
| Retrospective multicentric (six university hospitals) | 85 (47 MRIb) | 58 | Preoperative operative DWIe and fluid attenuated inversion recovery sequences MRIb within 14 days after diagnosis; imaging reviewed by an experienced neurologist in clinical blinding; only few patients underwent T2* GREf sequences; no microhemorrhages investigation | 55 % of patients had acute ischemic lesions, 60 % had small lesions, 77 % had multiple lesions, 64 % had lesions in multiple vascular territories; plasma CRPh level and white blood cell count were associated with ischemic lesions (ORs 2.3 and 2.2, respectively); no associations were found between postoperative complications and preoperative acute ischemic lesions; only three patients underwent postoperative neurologic complications; mean time from MRIb to cardiac surgery was 22 days | No | No |
Iung et al., 2012, European Heart Journal Cardiovascular Imaging, France [8] | 2005–2008 | Definite or possible acute IEa according to modified Duke criteria and “excluded” IEa with high clinical suspicion | Prospective monocentric; diagnostic classification and therapeuticplans establishment by two experts before and after MRIb; comparison of the two assessments | 58 | 61 | Cerebral and abdominal MRIb; standardized protocol; double blinding; MRIb <7 days of diagnosis; GREf and DWIe sequences | Based on MRIb results and excluding CMBsc: 19 % modified therapeutic plans, 28 % modified diagnostic classification | No | No |
Funakoshi et al., 2011, The Journal of Thoracic and Cardiovascular Surgery, Japan [34] | 2006–2010 | Active native valve IEa with surgical indication | Retrospective monocentric | 18 | 53 | Preoperative angio-MRIb; GREf and DWIe sequences | Urgent surgery for 15 patients; among them, 10 (67 %) showed IEa brain lesions, ten patients had acute or subacute brain infarctions, two had brain infarction with abscess, and two had hemorrhagic brain infarction and did not go on to have surgery | No | No |
Jeon et al., 2010, Cerebrovascular Disease, Korea [25] | 2005–2006 | No previous cardiac surgery and elective cardiac surgery | Prospective monocentric | 45 (19 MRIb) | 53 | Preoperative and postoperative GREf and DWIe; MRIb; standardized protocol; double blinding; interpretation | 26 new postoperative GREf lesions in 12 patients | Four patients | No |
Snygg-Martin et al., 2008, Clinical Infectious Diseases, Sweden [10] | 1998–2001, 2002–2005 | High clinical suspicion of left-side IEa
| Prospective bicentric | 60 (49 MRIb) | 63.5 | Brain MRIb or CTg scan <10 days of antibiotics; cerebrospinal fluids analyses of inflammatory and neurochemical markers of brain damage; no DWIe MRI sequences | 65 % cerebrovascular complications, 30 % were silent | No | No |
Duval et al., 2010, Annals of Internal Medicine, France [11] | 2005–2008 | Definite or possible acute IEa according to modified Duke criteria and “excluded” IEa with high clinical suspicion | Prospective monocentric; cohort study; two experts jointly established the endocarditis diagnostic classification and therapeutic plans just before and after MRIb and then compared them | 130 | 59 | Cerebral MRIb within 7 days after admission and before any surgical intervention; double blinding; MRIb <7 days of diagnoses; GREf and DWIe sequences | 82 % MRIb abnormalities; diagnostic classification of 32 % of cases of indefinite IEa was upgraded in 18 % of therapeutic plans, modifications including 14 % surgical changes | No | No |
Grabowski et al., 2011, J of Neurology, Poland [8] | 2002–2008 | IEa diagnosis according to modified Duke criteria without prevented neuroimaging examinations or evident hemorrhagic stroke | Prospective monocentric | 65 (52 MRIb) | 49 | MRIb or CTg Imaging | Of 65 patients: 13 patients with a clinical neurologic event, 24 patients with silent embolism (46 %), a total of 37 patients with neurologic lesions (56.9 %) | No | No |
Azuma et al., 2009, Japanese Journal of Radiology, Japan [17] | 2004–2006 | IEa with clinical neurologic complications | Retrospective monocentric | 14 | 70.4 | Cerebral MRIb within 9 days following admission; only four T1 gadolinium imaging; DWIe only for 13 patients; T2* GREf only for three patients | Thirteen patients had cerebral lesion embolization: in ten patients, most often in multiple territories, mainly in cortical and subcortical areas for nine; 57 % of cases involved the middle cerebral artery and 42.9 % of cases concerned the posterior cerebral artery; three cases of intracranial bleeding, three abscesses, two cerebritis; four patients presented CMBsc; half of the patients had more than two abnormal MRIb findings | No | No |