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. 2015 Jan-Feb;21(1):28-33.
doi: 10.5152/dir.2014.14239.

The utility of cardiac MRI in diagnosis of infective endocarditis: preliminary results

Memduh Dursun  1 , Sabri Yılmaz, Erdem Yılmaz, Ravza Yılmaz, İmran Onur, Hüseyin Oflaz, Aygün Dindar
Affiliations

The utility of cardiac MRI in diagnosis of infective endocarditis: preliminary results

Memduh Dursun et al. Diagn Interv Radiol. 2015 Jan-Feb.

Abstract

Purpose: We aimed to evaluate the utility of cardiac magnetic resonance imaging (MRI) for the diagnosis of infective endocarditis (IE).

Methods: Sixteen patients with a preliminary diagnosis of IE (10 women and six men; age range, 4-66 years) were referred for cardiac MRI. MRI sequences were as follows: echo-planar cine true fast imaging with steady-state precession (true-FISP), dark-blood fast spin echo T1-weighted imaging, T2-weighted imaging, dark-blood half-Fourier single shot turbo spin echo (HASTE), and early contrast-enhanced first-pass fast low-angle shot (FLASH). Delayed contrast-enhanced images were obtained using three-dimensional inversion recovery FLASH after 15±5 min. The MRI features were evaluated, including valvular pathologies on cine MRI and contrast enhancement on the walls of the cardiac chambers, major thoracic vasculature, and paravalvular tissue, attributable to endothelial extension of inflammation on contrast-enhanced images.

Results: Fourteen valvular vegetations were detected in eleven patients on cardiac MRI. It was not possible to depict valvular vegetations in five patients. Vegetations were detected on the aortic valve (n=7), mitral valve (n=3), tricuspid and pulmonary valves (n=1). Delayed contrast enhancement attributable to extension of inflammation was observed on the aortic wall and aortic root (n=11), paravalvular tissue (n=4), mitral valve (n=2), walls of the cardiac chambers (n=6), interventricular septum (n=3), and wall of the pulmonary artery and superior mesenteric artery (n=1).

Conclusion: Valvular vegetation features of IE can be detected by MRI. Moreover, in the absence of vegetations, detection of delayed enhancement representing endothelial inflammation of the cardiovascular structures can contribute to the diagnosis and treatment planning of IE.

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Figures

Figure 1.
Figure 1.
a–c. Vegetations observed in three different patients on cine MRI. Single vegetations (arrows) are noticed on the tricuspid valve (a) and the aortic valve (b). Panel (c) shows two vegetations detected on the aortic valve (arrow).
Figure 2.
Figure 2.
a–c. Direct extension of IE to the paravalvular tissue and interventricular septum in a 47-year-old male on cardiac cine MRI. Cine image (a) shows a large vegetation on the aortic valve (arrow) and signal changes of blood flow secondary to severe stenosis in the aorta (asterisk). Precontrast T1-weighted image (b) shows a hypointense vegetation (arrow), paravalvular tissue, and interventricular septum (arrowhead). Contrast enhancement of the vegetation (arrow), paravalvular tissue, and interventricular septum (arrowheads) is seen secondary to direct extension of IE (c).
Figure 3.
Figure 3.
a–d. Antegrade and retrograde extension of IE in a 48-year-old male with aortic insufficiency. Panel (a) shows leaflet thickening secondary to vegetation on the aortic valve (curved arrow). Panel (b) shows a jet flow towards the anterior leaflet of the mitral valve due to aortic insufficiency (arrow). Delayed contrast-enhanced image (c) shows retrograde extension of the infection on the anterior leaflet of the mitral valve (arrow). Panel (d) shows delayed contrast enhancement on the endothelium of the aorta (arrows) and superior mesenteric artery wall (arrowheads) secondary to antegrade extension of IE.
Figure 4.
Figure 4.
a, b. Cine and delayed enhanced cardiac images show direct and flow-related extension to the adjacent tissue and endocardium in a six-year-old girl. Cine image (a) shows two vegetations on the mitral valve (arrow) and signal changes due to severe mitral valve insufficiency (asterisk). Postcontrast image (b) shows delayed contrast enhancement secondary to direct extension of the infection in the adjacent paravalvular tissue (arrowheads) and right and left ventricular endocardial surface of the interventricular septum secondary to flow-related extension of the infection (arrows).
Figure 5.
Figure 5.
Left-to-right jet flow through the ventricular septal defect (arrow) is observed on cine images in a four-year-old girl.
See this image and copyright information in PMC

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