Cerebral microbleeds predict infectious intracranial aneurysm in infective endocarditis

摘要

Background and purpose Magnetic resonance imaging (MRI) features such as cerebral microbleeds and sulcal susceptibility‐weighted imaging ( SWI ) or gradient‐echo T2* lesions in infective endocarditis ( IE ) have been associated with the presence of infectious intracranial aneurysm ( IIA ). Our aim was to validate these MRI predictors for IIA in order to better assist in assessing the appropriate indications for digital subtraction angiography ( DSA ). Methods The derivation cohort comprised IE patients with neurological evaluation, MRI and DSA at a single tertiary referral center from January 2015 to July 2016. Validation was performed in a cohort of IE patients who underwent MRI and DSA at the same center from 2010 to 2014. Results Of 62 patients in the derivation cohort, 10 (16%) had IIA s. Of 129 in the validation cohort, 19 (15%) IIA s were identified. The MRI predictors for IIA consist of (i) contrast enhancement with microbleeds, (ii) cerebral microbleeds 5 mm or sulcal SWI lesions and (iii) any MRI hemorrhages. The sensitivity for the presence of IIA in each group of the derivation cohort was 90%, 80% and 100%, respectively. The sensitivity in the validation cohort was 47%, 68% and 94% respectively. The specificity in the derivation cohort was 87%, 85% and 18%. In the validation cohort, the specificity was similar at 87%, 75% and 27%. Conclusions The absence of MRI hemorrhages may not necessitate the need for DSA .