Detection and characterization of intracardiac thrombi on MR imaging.
OBJECTIVE
The aim of our study was to compare the diagnostic accuracy achieved using different MR techniques with the diagnostic accuracy achieved using transthoracic and transesophageal echocardiography to detect intracardiac thrombi.


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.


RESULTS
MR imaging and echocardiography revealed 12 thrombi-two in the right atrium, one in the right ventricle, three in the left atrium, and six in the left ventricle. Compared with echocardiography, MR imaging revealed three 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 seven 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 characterized as organized clots.


CONCLUSIONS
Contrast-enhanced inversion recovery turbo FLASH sequences 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 characterization of thrombi may be used to predict the risk of embolism, which is higher for subacute clots than for organized thrombi.
Barkhausen
Jörg
J
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
Hunold
Peter
P
Eggebrecht
Holger
H
Schüler
Walter O
WO
Sabin
Georg V
GV
Erbel
Raimund
R
Debatin
Jörg F
JF
D000328:Adult; D000368:Aged; D003287:Contrast Media; D004452:Echocardiography; D005260:Female; D019786:Gadolinium DTPA; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006331:Heart Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging
D003287:Contrast Media; D019786:Gadolinium DTPA