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Vol 13, No 1 (2018)
Original Papers
Published online: 2018-03-22
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Cardiac magnetic resonance imaging for detect intracardiac thrombi

Narumol Chaosuwannakit, Pattarapong Makarawate
DOI: 10.5603/FC.2018.0002
·
Folia Cardiologica 2018;13(1):9-14.

open access

Vol 13, No 1 (2018)
Original Papers
Published online: 2018-03-22

Abstract

Introduction. The aim of our study was to compare the diagnostic accuracy achieved using different magnetic resonance
(MR) techniques with the diagnostic accuracy achieved using transthoracic and transoesophageal echocardiography
to detect intracardiac thrombi.
Materials and methods. Twenty-four patients with known or suspected intracardiac thrombi were examined using MR
imaging and echocardiography. All MR examinations were performed on a 1.5-T MR scanner using dark-blood-prepared
half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences, fast imaging steady-state free precession
(trueFISP) cine sequences, and inversion recovery gradient-echo fast low-angle shot (inversion recovery turbo FLASH)
sequences after injection of 0.2 mmoL/kg of gadolinium diethylene triamine pentaacetic acid (myocardial delayed
enhancement).
Results. MR imaging and echocardiography revealed 12 thrombi as following: 2 in the right atrium, 1 in the right ventricle,
3 in the left atrium, and 6 in the left ventricle. Compared with echocardiography, MR imaging revealed 3 additional
thrombi in the left ventricle; these thrombi were confirmed at surgery. All 15 thrombi appeared as filling defects on early
contrast-enhanced inversion recovery turbo FLASH MR images. Only 7 thrombi were detected on HASTE images, and 10
thrombi were seen on trueFISP images. Four thrombi showed enhancement 10–20 min after contrast material injection
and were characterised as organised clots.
Conclusions. The contrast-enhanced inversion recovery turbo FLASH sequences (myocardial delayed enhancement)
were superior to dark-blood-prepared HASTE and trueFISP cine MR images in revealing intracardiac thrombi. Compared
with transthoracic echocardiography, MR imaging was more sensitive for the detection of left ventricular thrombi. The
characterisation of thrombi may be used to predict the risk of embolism, which is higher for subacute clots than for
organised thrombi.

Abstract

Introduction. The aim of our study was to compare the diagnostic accuracy achieved using different magnetic resonance
(MR) techniques with the diagnostic accuracy achieved using transthoracic and transoesophageal echocardiography
to detect intracardiac thrombi.
Materials and methods. Twenty-four patients with known or suspected intracardiac thrombi were examined using MR
imaging and echocardiography. All MR examinations were performed on a 1.5-T MR scanner using dark-blood-prepared
half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences, fast imaging steady-state free precession
(trueFISP) cine sequences, and inversion recovery gradient-echo fast low-angle shot (inversion recovery turbo FLASH)
sequences after injection of 0.2 mmoL/kg of gadolinium diethylene triamine pentaacetic acid (myocardial delayed
enhancement).
Results. MR imaging and echocardiography revealed 12 thrombi as following: 2 in the right atrium, 1 in the right ventricle,
3 in the left atrium, and 6 in the left ventricle. Compared with echocardiography, MR imaging revealed 3 additional
thrombi in the left ventricle; these thrombi were confirmed at surgery. All 15 thrombi appeared as filling defects on early
contrast-enhanced inversion recovery turbo FLASH MR images. Only 7 thrombi were detected on HASTE images, and 10
thrombi were seen on trueFISP images. Four thrombi showed enhancement 10–20 min after contrast material injection
and were characterised as organised clots.
Conclusions. The contrast-enhanced inversion recovery turbo FLASH sequences (myocardial delayed enhancement)
were superior to dark-blood-prepared HASTE and trueFISP cine MR images in revealing intracardiac thrombi. Compared
with transthoracic echocardiography, MR imaging was more sensitive for the detection of left ventricular thrombi. The
characterisation of thrombi may be used to predict the risk of embolism, which is higher for subacute clots than for
organised thrombi.

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Keywords

cardiac MRI, cardiac thrombi

About this article
Title

Cardiac magnetic resonance imaging for detect intracardiac thrombi

Journal

Folia Cardiologica

Issue

Vol 13, No 1 (2018)

Pages

9-14

Published online

2018-03-22

DOI

10.5603/FC.2018.0002

Bibliographic record

Folia Cardiologica 2018;13(1):9-14.

Keywords

cardiac MRI
cardiac thrombi

Authors

Narumol Chaosuwannakit
Pattarapong Makarawate

References (28)
  1. Chartier L, Béra J, Delomez M, et al. Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients. Circulation. 1999; 99(21): 2779–2783.
  2. Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988; 19(9): 1083–1092.
  3. Daniel WG, Mügge A. Transesophageal echocardiography. N Engl J Med. 1995; 332(19): 1268–1279.
  4. Shah DJ, Judd RM, Kim J. Myocardial viability. In: Edelman RR, Hesselink JR, Zlatkin M, Crues JV. ed. Clinical magnetic resonance imaging. 3rd edition. Elsevier, New York 2006: 1030–1049.
  5. Simonetti OP, Kim RJ, Fieno DS, et al. An improved MR imaging technique for the visualization of myocardial infarction. Radiology. 2001; 218(1): 215–223.
  6. Barkhausen J, Ruehm SG, Goyen M, et al. MR evaluation of ventricular function: true fast imaging with steady-state precession versus fast low-angle shot cine MR imaging: feasibility study. Radiology. 2001; 219(1): 264–269.
  7. Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart. 2012; 98(23): 1743–1749.
  8. Palazzuoli A, Ricci D, Lenzi C, et al. Transesophageal echocardiography for identifying potential cardiac sources of embolism in patients with stroke. Neurol Sci. 2000; 21(4): 195–202.
  9. Kitayama H, Kiuchi K, Endo T, et al. Value of cardiac ultrafast computed tomography for detecting right atrial thrombi in chronic atrial fibrillation. Am J Cardiol. 1997; 79(9): 1292–1295.
  10. Barkhausen J, Hunold P, Eggebrecht H, et al. Detection and characterization of intracardiac thrombi on MR imaging. AJR Am J Roentgenol. 2002; 179(6): 1539–1544.
  11. Jungehülsing M, Sechtem U, Theissen P, et al. Left ventricular thrombi: evaluation with spin-echo and gradient-echo MR imaging. Radiology. 1992; 182(1): 225–229.
  12. Sparrow PJ, Kurian JB, Jones TR, et al. MR imaging of cardiac tumors. Radiographics. 2005; 25(5): 1255–1276.
  13. Buckley O, Madan R, Kwong R, et al. Cardiac masses, part 1: imaging strategies and technical considerations. AJR Am J Roentgenol. 2011; 197(5): W837–W841.
  14. Mousseaux E, Hernigou A, Azencot M, et al. Evaluation by electron beam computed tomography of intracardiac masses suspected by transoesophageal echocardiography. Heart. 1996; 76(3): 256–263.
  15. Raggi P, Daniels M, Shanoudy H, et al. MRI misinterpretation of spontaneous echo-contrast as a large left atrial thrombus. Int J Card Imaging. 1996; 12(2): 85–88.
  16. Giardina EG. Atrial fibrillation and stroke: elucidating a newly discovered risk factor. Am J Cardiol. 1997; 80(4C): 11D–18D; discussion 35D.
  17. Kingdon EJ, Holt SG, Davar J, et al. Atrial thrombus and central venous dialysis catheters. Am J Kidney Dis. 2001; 38(3): 631–639.
  18. Sabzi F, Nasiri B. Myxoma of the superior vena cava origin presented as a right atrial mass. J Tehran Heart Cent. 2013; 8(4): 202–204.
  19. Farfel Z, Shechter M, Vered Z, et al. Review of echocardiographically diagnosed right heart entrapment of pulmonary emboli-in-transit with emphasis on management. Am Heart J. 1987; 113(1): 171–178.
  20. Staubach P. [Large right atrial aneurysm: rare cause of recurrent pulmonary embolism]. Z Kardiol. 1998; 87(11): 894–899.
  21. Schwab J, Schwab M, Manger K, et al. [Churg-Strauss syndrome with right ventricular tumor]. Dtsch Med Wochenschr. 1998; 123(16): 487–492.
  22. Mogulkoc N, Burgess MI, Bishop PW. Intracardiac thrombus in Behçet's disease: a systematic review. Chest. 2000; 118(2): 479–487.
  23. McCarthy K, Tang AT, Dalrymple-Hay MJ, et al. Ventricular thrombosis and systemic embolism in bodybuilders: etiology and management. Ann Thorac Surg. 2000; 70(2): 658–660.
  24. De Cock C, Lemaitre J, Deuvaert FE. Löeffler endomyocarditis: a clinical presentation as right ventricular tumor. J Heart Valve Dis. 1998; 7(6): 668–671.
  25. Schlotterbeck K, Schmid J, Bosse O, et al. [Experiences in the diagnosis and therapy of so-called thrombus in transit]. Z Kardiol. 1999; 88(11): 932–940.
  26. Casazza F, Bongarzoni A, Centonze F, et al. Prevalence and prognostic significance of right-sided cardiac mobile thrombi in acute massive pulmonary embolism. Am J Cardiol. 1997; 79(10): 1433–1435.
  27. Chapoutot L, Nazeyrollas P, Metz D, et al. Floating right heart thrombi and pulmonary embolism: diagnosis, outcome and therapeutic management. Cardiology. 1996; 87(2): 169–174.
  28. Goyen M, Laub G, Ladd ME, et al. Dynamic 3D MR angiography of the pulmonary arteries in under four seconds. J Magn Reson Imaging. 2001; 13(3): 372–377.

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