title: Improved echocardiographic delineation of left ventricular thrombus with the use of intravenous second-generation contrast image enhancement.
abstract: Transthoracic echocardiography is the most widely used diagnostic test for left ventricular (LV) thrombus, which must be distinguished from other intraventricular structures and image artifacts. To determine whether second-generation intravenous echocardiographic contrast agents provide better delineation of LV thrombus, we reviewed the results of 2-dimensional echocardiographic studies that were performed in 409 patients over a 1-year period to detect LV thrombus. Studies of 190 (46%) patients were interpreted as nondiagnostic for this purpose, of which 48 patients underwent an additional study after intravenous injection of 0.5 to 2 mL of human albumin microspheres within 1 to 4 days. In 43 (90%) of these 48 patients the contrast-enhanced study was definitive and diagnostic for either the presence or absence of an LV thrombus (P <.0001). Of the initial total of 409 patients, 81 had been studied at the bedside in intensive care units. The bedside studies were nondiagnostic for LV thrombus in 51 (63%) of these 81 patients. Of these 51 patients, 14 underwent additional imaging with contrast enhancement, and the contrast-enhanced images became diagnostic (P =. 004) in 11 (79%) of them. Thus intravenous contrast image enhancement improves the diagnostic yield of echocardiography in patients in whom initial images are nondiagnostic for LV thrombus.
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, Saint Louis, MO 63110, USA.
authors.forename: S
authors.initials: S
authors.lastname: Thanigaraj
authors.forename: K B
authors.initials: KB
authors.lastname: Schechtman
authors.forename: J E
authors.initials: JE
authors.lastname: Pérez
mesh_terms: D000418:Albumins / Q000008:administration & dosage; D016477:Artifacts; D003287:Contrast Media; D003325:Coronary Care Units; D003937:Diagnosis, Differential; D004452:Echocardiography; D005466:Fluorocarbons / Q000008:administration & dosage; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007275:Injections, Intravenous; D008863:Microspheres; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000000981:diagnostic imaging*
chemical_list: D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons