title: Black-blood thrombus imaging (BTI): a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis.
abstract: BACKGROUND
  ﻿Deep vein thrombosis (DVT) is a common but elusive illness that can result in long-term disability or death. Accurate detection of thrombosis and assessment of its size and distribution are critical for treatment decision-making. In the present study, we sought to develop and evaluate a cardiovascular magnetic resonance (CMR) black-blood thrombus imaging (BTI) technique, based on delay alternating with nutation for tailored excitation black-blood preparation and variable flip angle turbo-spin-echo readout, for the diagnosis of non-acute DVT.﻿ METHODS: This prospective study was approved by institutional review board and informed consent obtained from all subjects. BTI was first conducted in 11 healthy subjects for parameter optimization and then conducted in 18 non-acute DVT patients to evaluate its diagnostic performance. Two clinically used CMR techniques, contrast-enhanced CMR venography (CE-MRV) and three dimensional magnetization prepared rapid acquisition gradient echo (MPRAGE), were also conducted in all patients for comparison. All images obtained from patients were analyzed on a per-segment basis. Using the consensus diagnosis of CE-MRV as the reference, the sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV), and accuracy (ACC) of BTI and MPRAGE as well as their diagnostic agreement with CE-MRV were calculated. Besides, diagnostic confidence and interreader diagnostic agreement were evaluated for all three techniques.
  
  
  RESULTS
  BTI with optimized parameters effectively nulled the venous blood flow signal and allowed directly visualizing the thrombus within the black-blood lumen. Higher SE (90.4% vs 67.6%), SP (99.0% vs. 97.4%), PPV (95.4% vs. 85.6%), NPV (97.8% vs 92.9%) and ACC (97.4% vs. 91.8%) were obtained by BTI in comparison with MPRAGE. Good diagnostic confidence and excellent diagnostic and interreader agreements were achieved by BTI, which were superior to MPRAGE on detecting the chronic thrombus.
  
  
  CONCLUSIONS
  BTI allows direct visualization of non-acute DVT within the dark venous lumen and has the potential to be a reliable diagnostic tool without the use of contrast medium.
authors.affiliation: Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, CAS, Guangdong, 518055, China.|Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Pacific Theatres Building, Suite 800, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
authors.forename: Guoxi
authors.initials: G
authors.lastname: Xie
authors.affiliation: Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China.
authors.forename: Hanwei
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China.|Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510405, China.
authors.forename: Xueping
authors.initials: X
authors.lastname: He
authors.affiliation: Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China.
authors.forename: Jianke
authors.initials: J
authors.lastname: Liang
authors.affiliation: Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Deng
authors.affiliation: Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China.
authors.forename: Zhuonan
authors.initials: Z
authors.lastname: He
authors.affiliation: Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China.
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Ye
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Pacific Theatres Building, Suite 800, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.|Department of Radiology, Xuanwu Hospital, Beijing, 100053, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Yang
authors.affiliation: MR R&D, Siemens Healthcare, Los Angeles, CA, 90048, USA.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Bi
authors.affiliation: Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, CAS, Guangdong, 518055, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Pacific Theatres Building, Suite 800, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
authors.forename: Debiao
authors.initials: D
authors.lastname: Li
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Pacific Theatres Building, Suite 800, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA. fanzhaoyang@gmail.com.
authors.forename: Zhaoyang
authors.initials: Z
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002908:Chronic Disease; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010690:Phlebography / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Black-blood thrombus imaging; Cardiovascular Magnetic Resonance; Deep vein thrombosis