早期脑部磁共振成像对感染性心内膜炎临床决策的影响：一项前瞻性研究。
Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study.
机构信息
Paris 7 University Medical School, AP-HP Bichat University Hospital, and INSERM CIC 007, Paris, France.
出版信息
Ann Intern Med. 2010 Apr 20;152(8):497-504, W175. doi: 10.7326/0003-4819-152-8-201004200-00006.
BACKGROUND
Neurologic complications of endocarditis can influence diagnosis, therapeutic plans, and prognosis.
OBJECTIVE
To describe how early cerebral magnetic resonance imaging (MRI) affects the diagnosis and management of endocarditis in hospitalized adults.
DESIGN
Single-center prospective study between June 2005 and October 2008. (ClinicalTrials.gov registration number: NCT00144885)
SETTING
Tertiary care university hospital in France.
PATIENTS
130 patients with endocarditis.
INTERVENTION
Cerebral MRI with angiography performed up to 7 days after admission and before any surgical intervention.
MEASUREMENTS
2 experts jointly established the endocarditis diagnostic classification (according to Duke-modified criteria) and therapeutic plans just before and after MRI and then compared them.
RESULTS
Endocarditis was initially classified as definite in 77 patients and possible in 50 and was excluded in 3. Sixteen patients (12%) had acute neurologic symptoms. Cerebral lesions were detected by MRI in 106 patients (82% [95% CI, 75% to 89%]), including ischemic lesions in 68, microhemorrhages in 74, and silent aneurysms in 10. Solely on the basis of MRI results and excluding microhemorrhages, diagnostic classification of 17 of 53 (32%) cases of nondefinite endocarditis was upgraded to either definite (14 patients) or possible (3 patients). Endocarditis therapeutic plans were modified for 24 (18%) of the 130 patients, including surgical plan modifications for 18 (14%). Overall, early MRI led to modifications of diagnosis or therapeutic plan in 36 patients (28% [CI, 20% to 36%]).
LIMITATION
Investigators did not assess whether the MRI-related changes in diagnosis and therapeutic plans improved patient outcomes or led to unnecessary procedures and increased costs.
CONCLUSION
Cerebral lesions were identified by MRI in many patients with endocarditis but no neurologic symptoms. The MRI findings affected both diagnostic classifications and clinical management plans.
PRIMARY FUNDING SOURCE
French Ministry of Health.
背景
心内膜炎的神经系统并发症会影响诊断、治疗计划和预后。
目的
描述早期脑磁共振成像（MRI）如何影响住院成人的心内膜炎的诊断和治疗。
设计
2005 年 6 月至 2008 年 10 月进行的单中心前瞻性研究。（ClinicalTrials.gov 注册号：NCT00144885）
地点
法国的一家三级保健大学医院。
患者
130 例心内膜炎患者。
干预措施
入院后 7 天内并在任何手术干预之前进行脑部 MRI 检查，包括血管造影。
测量
2 位专家共同制定心内膜炎诊断分类（根据改良的 Duke 标准）和治疗计划，然后在 MRI 前后进行比较。
结果
心内膜炎最初被分类为明确心内膜炎 77 例，可能心内膜炎 50 例，排除 3 例。16 例（12%）患者有急性神经系统症状。106 例患者（82%[95%CI，75%至 89%]）通过 MRI 发现脑部病变，包括 68 例缺血性病变、74 例微出血和 10 例无症状性动脉瘤。仅基于 MRI 结果且排除微出血后，53 例非明确心内膜炎病例中的 17 例（32%）诊断分类升级为明确（14 例）或可能（3 例）。130 例患者中有 24 例（18%）治疗计划发生改变，包括 18 例（14%）手术计划改变。总的来说，36 例（28%[95%CI，20%至 36%]）患者的诊断或治疗计划因早期 MRI 而发生改变。
局限性
研究者未评估 MRI 相关诊断和治疗计划的改变是否改善了患者结局，或是否导致了不必要的程序和增加了成本。
结论
许多有心内膜炎但无神经系统症状的患者通过 MRI 发现了脑部病变。MRI 结果影响了诊断分类和临床管理计划。
主要资金来源
法国卫生部。
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