AIM: Early MRI for endocarditis may result in treatment changes
According to a trial published in the April edition of the Annals of Internal Medicine, early cerebral MRI-identified lesions in patients with endocarditis but no neurologic symptoms can yield a change in the clinical management plan for the patient, and affect diagnostic classification.
Xavier Duval, MD, PhD, of Paris 7 University Medical School, AP-HP Bichat University Hospital in Paris and colleagues postulated that neurologic complications of endocarditis can influence diagnosis, therapeutic plans and prognosis for patients, and their study sought to describe how this early imaging could affect hospitalized adults.
Conducted at a single-center, tertiary-care hospital in France, the researchers recruited 130 admitted patients with endocarditis between June 2005 and October 2008. The authors wrote that cerebral MRI with angiography was administered up to seven days following admission and before any surgical intervention to the patients within this cohort.
Based on Duke-modified criteria, two experts mutually established a diagnosis of Endocarditis as one classification of the patients, as well as created a preliminary plan for therapy and course of action for these patients before they underwent MRI. Following the MR exam, the experts created another therapeutic plan, in which the authors compared for differences.
Initially, the authors determined that endocarditis was definite in 77 patients, possible in 50 and was ruled-out in three patients. Of this population, 12 percent of patients presented with neurologic symptoms. In 82 percent of patients, MRI exams detected cerebral lesions, including ischemic lesions in 68, microhemorrhages in 74 and silent aneurysms in 10 individuals.
Based on the results of the MRI exam and excluding microhemorrhages, the authors wrote, “diagnostic classification of 17 of 53 (32 percent) cases of nondefinite endocarditis was upgraded to either definite (14 patients) or possible (three patients).”
After reclassification, Duval and colleagues noted that the original therapeutic plans of the 130 patients were adjusted for 24 individuals (18 percent of the cohort). In addition, surgical plans were found to have been modified for 18 patients (14 percent). “Overall, early MRI led to modifications of diagnosis or therapeutic plan in 36 patients (28 percent),” wrote the authors.
However, further research into this method is warranted, as the researchers said that while MRI findings affected both diagnostic classifications and clinical management plans for the patients, they did not assess whether the MRI-related changes in diagnosis and therapeutic plans improved patient outcomes or led to unnecessary procedures and increased costs.
Xavier Duval, MD, PhD, of Paris 7 University Medical School, AP-HP Bichat University Hospital in Paris and colleagues postulated that neurologic complications of endocarditis can influence diagnosis, therapeutic plans and prognosis for patients, and their study sought to describe how this early imaging could affect hospitalized adults.
Conducted at a single-center, tertiary-care hospital in France, the researchers recruited 130 admitted patients with endocarditis between June 2005 and October 2008. The authors wrote that cerebral MRI with angiography was administered up to seven days following admission and before any surgical intervention to the patients within this cohort.
Based on Duke-modified criteria, two experts mutually established a diagnosis of Endocarditis as one classification of the patients, as well as created a preliminary plan for therapy and course of action for these patients before they underwent MRI. Following the MR exam, the experts created another therapeutic plan, in which the authors compared for differences.
Initially, the authors determined that endocarditis was definite in 77 patients, possible in 50 and was ruled-out in three patients. Of this population, 12 percent of patients presented with neurologic symptoms. In 82 percent of patients, MRI exams detected cerebral lesions, including ischemic lesions in 68, microhemorrhages in 74 and silent aneurysms in 10 individuals.
Based on the results of the MRI exam and excluding microhemorrhages, the authors wrote, “diagnostic classification of 17 of 53 (32 percent) cases of nondefinite endocarditis was upgraded to either definite (14 patients) or possible (three patients).”
After reclassification, Duval and colleagues noted that the original therapeutic plans of the 130 patients were adjusted for 24 individuals (18 percent of the cohort). In addition, surgical plans were found to have been modified for 18 patients (14 percent). “Overall, early MRI led to modifications of diagnosis or therapeutic plan in 36 patients (28 percent),” wrote the authors.
However, further research into this method is warranted, as the researchers said that while MRI findings affected both diagnostic classifications and clinical management plans for the patients, they did not assess whether the MRI-related changes in diagnosis and therapeutic plans improved patient outcomes or led to unnecessary procedures and increased costs.