Value of brain MRI in infective endocarditis: a narrative literature review.

The nervous system is frequently involved in patients with infective endocarditis (IE). A systematic review of the literature was realized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). This study sought to systematically evaluate the published evidence of the contribution of brain magnetic resonance imaging (MRI) in IE. The aim was to identify studies presenting the incidence and type of MRI brain lesions in IE. Fifteen relevant studies were isolated using the Medline, Embase, and Cochrane databases. Most of them were observational studies with a small number of patients. MRI studies demonstrated a wide variety and high frequency of cerebral lesions, around 80 % of which were mostly clinically occult. This review shows MRI's superiority compared to brain computed tomography (CT) for the diagnosis of neurologic complications. Recent developments of sensitive MRI sequences can detect microinfarction and cerebral microhemorrhages. However, the clinical significance of these microhemorrhages, also called cerebral microbleeds (CMBs), remains uncertain. Because some MRI neurological lesions are a distinctive IE feature, they can have a broader involvement in diagnosis and therapeutic decisions. Even if cerebral MRI offers new perspectives for better IE management, there is not enough scientific proof to recommend it in current guidelines. The literature remains incomplete regarding the impact of MRI on concerted decision-making. The long-term prognosis of CMBs has not been evaluated to date and requires further studies. Today, brain MRI can be used on a case-by-case basis based on a clinician's appraisal.

Is brain angio-MRI useful in infective endocarditis management?

In infective endocarditis (IE), brain magnetic resonance imaging (MRI) is helpful to diagnose clinically silent neurological events. We assessed the usefulness of systematic early brain MRI in IE diagnosis and medico-surgical management. Over a period of 1 year, all patients admitted in one of the three hospitals participating in and fulfilling the Duke criteria for definite or possible IE underwent cerebral MRI within 7 days of IE suspicion. Eight panels of experts analyzed the records a posteriori. For each case, one record with and one record without the MRI results were randomly assigned to two panels, which determined the theoretical diagnosis and treatment. Paired comparisons were performed using a symmetry test. Thirty-seven brain MRIs were performed within a median of 5 days after inclusion. MRI was pathological in 26 patients (70 %), showing 62 % microischemia and 58 % microbleeds. The expert advice did not differ significantly between the two evaluations (with or without the MRI results). The therapeutic strategies determined diverged in five cases (13.5 %). Diagnosis differed in two cases (5.4 %), with an upgrading of diagnosis from possible to definite IE using MRI results. Early brain MRI did not significantly affect the IE diagnosis and medico-surgical treatment plan. These results suggest that systematic use of early brain MRI is irrelevant in IE. Further studies are necessary to define whether MRI is mandatory in IE management within a multidisciplinary approach, with particular attention paid to better timing and the subset of patients in whom this imaging examination could be beneficial.

[Transperitoneal laparoscopic approach to the L5-S1 disk. Value of computed x-ray tomography]. / Abords du disque L5-S1 par coelioscopie trans-péritonéale, Intérêt d'une étude tomodensitométrique préalable.

PURPOSE OF THE STUDY: The aim of this study was to determine the laparoscopic approach of L5-S1 disk, by preoperative C.T. evaluation. MATERIAL AND METHODS: 30 patients justified tomodensitometry for low back pain or sciatalogy. We added two scan views and a lateral radiologic mode including pubis. We defined several parameters in order to evaluate the "useful" triangle limited by iliac veins and anterior edge of S1 plateau. This surface was divided in discal and vertebral surfaces. We studied also cutaneous projections of axis and usefull zones for discal or transcorporeal approach. RESULTS: The "usefull" surface was about 6 cm2 (from 0 to 13.12 cm2). The average vertebral surface was 2.58 cm2 and 3.42 cm2 for discal surface. The best cutaneous point for introduction was 3.3 cm from ombilic in transcorporeal approach and 11.3 cm in discal approach. DISCUSSION: Peroperative C.T. evaluation seems to be more usefull than radiological for preoperative planning. Peroperative radiographical control is not always efficient to prevent foraminal radicular risk.

[Post-traumatic gas in children. Apropos of a case]. / Aéroportie post-traumatique de l'enfant. A propos d'un cas.

The authors report a case of post-traumatic gas in the portal vein in a child. They stress the rarity of this lesion in such circumstances and recall the radiological signs together with the differential diagnoses and the principal aetiologies.