title: Cerebral microbleeds are frequent in infective endocarditis: a case-control study.
abstract: OBJECTIVE
  Cerebral microbleeds (CMBs) have been described using MRI in patients with cardiovascular risk factors or prior stroke and could be an indicator of small vessel disease. CMBs have been reported in isolated cases of infective endocarditis (IE), but their frequency and the association of CMBs with IE have not yet been studied.
  
  
  METHODS
  A case-control imaging study in a referral institutional tertiary care center was conducted. Systematic brain MRIs, including T2*-weighted sequences, were performed in 60 patients with IE within 7 days of hospital admission and in 120 age- and gender-matched control subjects without IE. Two neuroradiologists, who were blinded to patient characteristics, independently assessed the presence, location, and size of CMBs using a standardized form.
  
  
  RESULTS
  The interobserver agreement level on the presence of CMBs was high with a kappa coefficient range (95% CI) of 0.70 (0.42 to 0.98) for subcortical regions to 0.91 (0.82 to 0.99) for cortical areas. CMBs were more prevalent in patients with IE (57% [n=34]) than in control subjects (15% [n=18]; matched OR, 10.06; 95% CI, 3.88 to 26.07). Moreover, the OR of IE increased gradually with CMBs number with an OR of 6.12 (95% CI, 2.09 to 17.94) for one to 3 CMBs and of 20.12 (95% CI, 5.20 to 77.80) for >3 CMBs.
  
  
  CONCLUSIONS
  CMBs are highly frequent in patients with IE. The strong association found between IE and CMBs supports the need for further evaluation of CMBs as additional diagnostic criteria of IE.
authors.affiliation: Department of Radiology, Bichat University Hospital, 75018 Paris, France. isabelle.klein@bch.aphp.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Klein
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Agathe
authors.initials: A
authors.lastname: Hess
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
authors.forename: Philippa
authors.initials: P
authors.lastname: Lavallée
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Laissy
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis*; D004696:Endocarditis / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult