The Role Of Computed Tomography And Magnetic Resonance Imaging In The Diagnosis Of Perivalvular Complications And Myocardium Infiltration In Infectious Endocarditits

Introduction: Echocardiography - transthoracic (TTE) and/or transesophageal (TEE) remains the gold standard for the diagnosis of infective endocarditis (IE). Aim of the study: To assess the usefulness of cardiac computed tomography and cardiac magnetic resonance in patients with infective endocarditis. Methods: The study included 79 consecutive patients with IE. Each patient underwent TTE and TEE. Cardiac computed tomography (CT) was performed in 71 patients. Cardiac magnetic resonance (CMR) imaging was performed in 20 patients. Fifty-nine patients were qualified for surgical treatment. Results: Among the patients who underwent CT, 53 were operated. In this group, intraoperative assessment revealed the presence of 11 abscesses/pseudoaneurysms. The combination of CT and echocardiography allowed all abscesses to be diagnosed. Inflammatory infiltration was found intraoperatively in 15 patients. The analysis of total TEE and CT findings showed that supplementing echocardiography with CT had increased the sensitivity of the method for detecting inflammatory infiltration to 76%.The sensitivity of TEE in the diagnosis of cusp perforation, perivalvular leakage and vegetation was higher than CT. CMR revealed vegetations in 15 patients, at echocardiography vegetations were found in 19 patients. Valve perforation was suspected in seven patients at echocardiography, and in six of these patients after CMR. In one patient after Bentall procedure, an inflammatory infiltration was seen around the prosthesis both at CMR and echocardiography. Among the 20 patients who underwent the CMR, the foci of late gadolinium enhancement (LGE) were found in 8 cases. The foci were identified in the interventricular septum, left ventricle walls and, in the case of the patient after Bentall procedure, around the aortic prosthesis. The foci were more common in patients with aortic valve IE. Conclusions: 1.Cardiac computed tomography examination is useful in the diagnosis of infective endocarditis and its local complications. 2.Magnetic resonance imaging may serve as a useful method for evaluating the degree of inflammatory process involvement in the myocardium.