title: Prediction of early postoperative cerebral hemorrhage in infective endocarditis patients using magnetic resonance imaging.
abstract: OBJECTIVE
  To evaluate the relationship between preoperative magnetic resonance imaging (MRI) findings and the occurrence of postoperative intracranial hemorrhage (ICH) in infective endocarditis (IE) patients.
  
  
  METHODS
  Between 2002 and 2012, 30 IE patients required surgical intervention. Four patients developed and 26 patients did not develop postoperative ICH. All patients underwent preoperative brain MRI. The presence of acute brain infarction was detected by diffusion-weighted imaging (DWI), and cerebral microbleeds were detected by T2*-weighted imaging.
  
  
  RESULTS
  Two ICH(+) patients died of stroke. Preoperative patient characteristics and operative results were not significantly different. Regarding MRI findings, the presence of cerebral microbleeds or acute brain infarction alone was not significantly different between the two groups (100 vs. 29.6 %, p = 0.07; 75.0 vs. 38.5 %, p = 0.37, respectively). The concurrent presence of cerebral microbleeds and acute brain infarction was significantly correlated with the development of major ICH (75 vs. 14.8 %, p = 0.04). In multiple logistic regression analyses, the concurrent presence of cerebral microbleeds and acute brain infarction on MRI was an independent predictor of major postoperative ICH (p = 0.03, odds ratio 16.5, 95 % confidence interval 1.35-201.3).
  
  
  CONCLUSIONS
  The combination of T2*-weighted MRI and DWI may be useful to evaluate the risk of IE patients developing major postoperative cerebral bleeding.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan, suguru19820411@yahoo.co.jp.
authors.forename: Suguru
authors.initials: S
authors.lastname: Ohira
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Doi
authors.forename: Hidetake
authors.initials: H
authors.lastname: Kawajiri
authors.forename: Masahiro
authors.initials: M
authors.lastname: Dohi
authors.forename: Tsunehisa
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Taiji
authors.initials: T
authors.lastname: Watanabe
authors.forename: Kazunari
authors.initials: K
authors.lastname: Okawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yaku
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000601:surgery; D020520:Brain Infarction / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D004697:Endocarditis, Bacterial / Q000601:surgery*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology*; D011300:Preoperative Care; D013203:Staphylococcal Infections / Q000601:surgery*; D013290:Streptococcal Infections / Q000601:surgery*; D020521:Stroke / Q000209:etiology