[Detection and characterization of left ventricular thrombi by MRI compared to transthoracic echocardiography].
OBJECTIVE
Transthoracic echocardiography is the routine diagnostic procedure in assessing patients with left ventricular thrombi, but is limited by the acoustic window and poor contrast between thrombus and adjacent myocardium. This study evaluates the role of cardiac MRI in the detection of left ventricular thrombi in patients with chronic myocardial infarction compared to standard transthoracic echocardiography.


METHODS
In 82 patients (55 men and 27 women, age 36 to 79 years, median 59 +/- 11 years) who suffered a myocardial infarction more than 6 months earlier, transthoracic echocardiography and MRI were performed. The MRI protocol included steady state cine imaging (true FISP: TR 3.0 ms, TE 1.5 ms, FA 65 degrees ) in standard long and short axis orientation and contrast-enhanced imaging using a 3D IR-FLASH sequence with long inversion time (TR 4 ms, TE 1.43 ms, FA 10 degrees , TI 300 ms) early, and a 2D IR-FLASH sequence with optimized inversion time (TR 8 ms, TE 4.3 ms, FA 20 degrees , TI 180 - 280 ms) late after administration of gadolinium.


RESULTS
Transthoracic echocardiography depicted 12 thrombi. Contrast-enhanced MRI confirmed these 12 thrombi and detected 23 additional thrombi. With the exception of 2 very small apical thrombi only visible on contrast-enhanced MR images, spherical thrombi were diagnosed by both techniques, whereas only contrast-enhanced MRI was able to visualize mural thrombi. Left ventricular thrombi were more frequently diagnosed in patients with moderate to severe impairment of the left ventricular systolic function, 32/42 (76 %), or in patients with left ventricular aneurysms, 21/24 (84 %).


CONCLUSIONS
Contrast-enhanced MRI is mostly superior to transthoracic echocardiography in diagnosing mural left ventricular thrombi in patients who had suffered a myocardial infarction. Intracavitary thrombi are more frequently found in patients with impaired regional and global left ventricular function.
Bruder
O
O
Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus Essen.
Waltering
K U
KU
Hunold
P
P
Jochims
M
M
Narin
B
B
Sabin
G V
GV
Barkhausen
J
J
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003287:Contrast Media; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography; D005260:Female; D019786:Gadolinium DTPA; D006322:Heart Aneurysm / Q000175:diagnosis; D006331:Heart Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D013927:Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA