title: Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction.
abstract: BACKGROUND
  Persistent intracoronary thrombus after plaque rupture is associated with an increased risk of subsequent myocardial infarction and mortality. Coronary thrombus is usually visualized invasively by x-ray coronary angiography. Non-contrast-enhanced T1-weighted magnetic resonance (MR) imaging has been useful for direct imaging of carotid thrombus and intraplaque hemorrhage by taking advantage of the short T1 of methemoglobin present in acute thrombus and intraplaque hemorrhage. The aim of this study was to investigate the use of non-contrast-enhanced MR for direct thrombus imaging (MRDTI) in patients with acute myocardial infarction.
  
  
  RESULTS
  Eighteen patients (14 men; age, 61±9 years) underwent MRDTI within 24 to 72 hours of presenting with an acute coronary syndrome before invasive x-ray coronary angiography; MRDTI was performed with a T1-weighted, 3-dimensional, inversion-recovery black-blood gradient-echo sequence without contrast administration. Ten patients were found to have intracoronary thrombus on x-ray coronary angiography (left anterior descending, 4; left circumflex, 2; right coronary artery, 4; and right coronary artery-posterior descending artery, 1), and 8 had no visible thrombus. We found that MRDTI correctly identified thrombus in 9 of 10 patients (sensitivity, 91%; posterior descending artery thrombus not detected) and correctly classified the control group in 7 of 8 patients without thrombus formation (specificity, 88%). The contrast-to-noise ratio was significantly greater in coronary segments containing thrombus (n=10) compared with those without visible thrombus (n=131; mean contrast-to-noise ratio, 15.9 versus 2.6; P<0.001).
  
  
  CONCLUSIONS
  Use of MRDTI allows selective visualization of coronary thrombus in a patient population with a high probability of intracoronary thrombosis.
authors: Division of Imaging Sciences, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK. Christian.Jansen@me.com
authors: C H P
authors: CH
authors: Jansen
authors: D
authors: D
authors: Perera
authors: M R
authors: MR
authors: Makowski
authors: A J
authors: AJ
authors: Wiethoff
authors: A
authors: A
authors: Phinikaridou
authors: R M
authors: RM
authors: Razavi
authors: M S
authors: MS
authors: Marber
authors: G F
authors: GF
authors: Greil
authors: E
authors: E
authors: Nagel
authors: D
authors: D
authors: Maintz
authors: S
authors: S
authors: Redwood
authors: R M
authors: RM
authors: Botnar
mesh_terms: D000368:Aged; D003287:Contrast Media; D003328:Coronary Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D011859:Radiography; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media