MRI versus CT in the detection of brain lesions in patients with infective endocarditis before/after cardiac surgery

Imaging of brain involvement in infective endocarditis can drive the clinical management of this serious condition. MRI is very sensitive, but CT is more readily available. In this retrospective study, we compared the detection rate of CT and MRI.

After Ethics Committee approval, we retrospectively reviewed a series of 20 patients (13 males, median age 64 years) who underwent both CT and MRI before or after cardiac surgery for definite infective endocarditis. Unenhanced CT and MRI were evaluated for acute ischemic lesions, both punctuate and large, intraparenchymal hemorrhages, cerebral microbleeds, subarachnoid hemorrhages, abscesses, microabscesses and meningitis. Qualitative and Cohen κ analysis were performed. The value of contrast-enhanced scans (MRI, n = 14; CT, n = 9) and cognitive status were also assessed.

While CT rapidly excludes large hemorrhages before cardiac surgery for infective endocarditis, MRI accurately distinguishes the whole spectrum of brain lesions.