title: First pass perfusion imaging to improve the assessment of left ventricular thrombus following a myocardial infarction.
abstract: OBJECTIVE
  To assess whether a first-pass perfusion sequence (FPP) improved the detection of left ventricular thrombus (LVT).
  
  
  METHODS
  Three hundred and twenty-nine patients with a first STEMI were prospectively included to undergo cardiac magnetic resonance (CMR) at baseline and after a 3-month follow-up. A CMR delayed analysis was performed by three blinded examiners (2 CMR experts and 1 novice) according to a two-step reading protocol. First, an analysis was performed on cine CMR and late gadolinium enhancement (routine stage). Then, the FPP stage was performed following initial protocol along with a FPP sequence.
  
  
  RESULTS
  LVT was found in 31 out of a total of 638 (4.9%) CMR scans, affecting 30 (9.1%) individuals. All were located in the left ventricular apex. The FPP stage improved significantly the LVT diagnosis for all readers, in 10 and 13 cases (32% and 42%) of LVT suspicion for the experts and 16 cases (41%) for the novice. Respectively 1, 2 and 6 LVT were not detected during the routine stage by the CMR experts and the novice. For the novice, the FPP stage improved diagnosis sensitivity from 78.1 to 91.2%.
  
  
  CONCLUSIONS
  The prevalence of LVT following a myocardial infarction reached 9.1% and increased with the reading of FPP sequence. The FPP stage improved expert diagnostic certitude and the novice's abilities to reach expert level.
authors: L'UNAM Université, Angers, France; Laboratoire de Cardioprotection, Remodelage et Thrombose, UPRES 3860, Service de Cardiologie, CHU d'Angers, Angers, France. Electronic address: lobiere@chu-angers.fr.
authors: Loïc
authors: L
authors: Bière
authors: L'UNAM Université, Angers, France; Laboratoire de Cardioprotection, Remodelage et Thrombose, UPRES 3860, Service de Cardiologie, CHU d'Angers, Angers, France.
authors: Martin
authors: M
authors: Audonnet
authors: L'UNAM Université, Angers, France; Laboratoire de Cardioprotection, Remodelage et Thrombose, UPRES 3860, Service de Cardiologie, CHU d'Angers, Angers, France.
authors: Guillaume
authors: G
authors: Clerfond
authors: L'UNAM Université, Angers, France; Laboratoire de Cardioprotection, Remodelage et Thrombose, UPRES 3860, Service de Cardiologie, CHU d'Angers, Angers, France.
authors: Hermeland
authors: H
authors: Delagarde
authors: L'UNAM Université, Angers, France; Service de Radiologie, CHU d'Angers, Angers, France.
authors: Serge
authors: S
authors: Willoteaux
authors: L'UNAM Université, Angers, France; Laboratoire de Cardioprotection, Remodelage et Thrombose, UPRES 3860, Service de Cardiologie, CHU d'Angers, Angers, France.
authors: Fabrice
authors: F
authors: Prunier
authors: L'UNAM Université, Angers, France; Laboratoire de Cardioprotection, Remodelage et Thrombose, UPRES 3860, Service de Cardiologie, CHU d'Angers, Angers, France.
authors: Alain
authors: A
authors: Furber
mesh_terms: D000368:Aged; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D009942:Organometallic Compounds; D011446:Prospective Studies; D015203:Reproducibility of Results; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine
keywords: Cardiac magnetic resonance imaging; Myocardial infarction; Perfusion imaging; Thrombus