TTE at the time of antimicrobial therapy comple- tion to establish baseline features is reasonable (Class IIa; Level of Evidence C). 3D Echocardiography and Other Imaging Modalities Although newer imaging modalities are undergoing pre- liminary evaluation, echocardiography will continue to be pivotal in patients with IE for the foreseeable future. In this regard, early investigations64,65 of 3D TEE have demonstrated advantages over 2-dimensional TEE (which is routinely used) to better detect and delineate vegetations and to identify IE complications and their relationships with surrounding struc- tures. Unfortunately, the lower temporal and lateral resolu- tion with 3D echocardiography compared with 2-dimensional echocardiography leads to an overestimation of vegetation size and technically challenging visualization of fast-moving structures. Although cardiac CT is used principally to evaluate great vessels and coronary artery disease, there may be a role for in cases of IE in which definitive evidence of IE and its complications is not secured with TEE. Moreover, coronary CT angiography can provide coronary artery evalu- ation in patients who are to undergo cardiac surgery for IE complications. In addition, this methodology may be useful in head-to-toe preoperative screening, including evaluation for central nervous system (CNS) lesions, and in intra-abdominal lesions (eg, silent splenic abscesses). Limitations include the associated exposure to radiation, nephrotoxicity associated with contrast dye, and relative lack of sensitivity in 1 study to demonstrate valve perforations.67 MRI has had a major impact on IE diagnosis and manage- ment, especially as a tool to detect cerebral embolic events, many of which are clinically silent.69 Indications for the rou- tine use of MRI and magnetic resonance angiography in IE management, however, are not well established. Comments related to mycotic or infectious aneurysms are provided in a later section of this document. 