Visualization of ventricular thrombi with contrast-enhanced magnetic resonance imaging in patients with ischemic heart disease.
BACKGROUND
Ventricular thrombus formation is a frequent and potentially dangerous complication in patients with ischemic heart disease. Although transthoracic echocardiography (TTE) is generally used as diagnostic technique, we explored the role of contrast-enhanced (CE)-MRI to detect ventricular thrombi.


RESULTS
In 57 patients with acute myocardial infarction, chronic myocardial infarction, or ischemic cardiomyopathy, MRI was performed to evaluate ventricular function (CINE-MRI) and to depict presence of myocardial necrosis and/or scarring and no-reflow areas (CE-MRI). All studies were analyzed for concomitant ventricular thrombi. CE-MRI depicted 12 mural thrombi (3.1+/-2.9 cm3), located in left ventricular (LV) apex or adherent to anteroseptum, presenting as black, well-defined structures surrounded by bright contrast-enhanced blood. Thrombus formation on CE-MRI was related to larger end-diastolic volumes; lower ejection fractions; the region of delayed enhancement and lowest wall motion score, especially in left anterior descending coronary artery territory; and LV aneurysm formation. On CINE-MRI, thrombi were found in 6 patients. Nonvisualized thrombi were usually small (mean size 1.2+/-0.7 cm3). TTE depicted thrombi in 5. Nonvisualized lesions were most frequently located in LV apex and had a larger size than nonvisualized lesions on CINE-MRI (3.0+/-3.2 cm3). In 3 patients with suspected apical thrombus on TTE, MRI was normal.


CONCLUSIONS
CE-MRI is not only an excellent technique to depict myocardial necrosis and scar tissue in patients with ischemic heart disease, but this study also suggests a better identification of LV thrombi than with presently used clinical imaging modalities, such as TTE.
Mollet
Nico R
NR
Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium.
Dymarkowski
Steven
S
Volders
Wim
W
Wathiong
Jurgen
J
Herbots
Lieven
L
Rademakers
Frank E
FE
Bogaert
Jan
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003287:Contrast Media / Q000008:administration & dosage; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D019786:Gadolinium DTPA; D006334:Heart Function Tests; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D020407:Internet; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis*; D009336:Necrosis; D011237:Predictive Value of Tests; D014741:Video Recording
D003287:Contrast Media; D019786:Gadolinium DTPA