Detection of thrombus size and protein content by ex vivo magnetization transfer and diffusion weighted MRI

Phinikaridou, Alkystis; Qiao, Ye; Giordano, Nick; Hamilton, James A.

doi:10.1186/1532-429x-14-45

Cited by 16 publications

(14 citation statements)

References 55 publications

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“…29 Similarly, ex vivo application of MT permitted the distinction between plateletrich and protein-rich thrombus in thrombosed rabbit plaque. 30 Here, we demonstrated the in vivo feasibility of MT for monitoring the evolution of venous thrombus at a clinically relevant field strength. MT uses saturation prepulses to destroy the magnetization of the bound-proton pool, resulting in images with reduced signal intensity that is proportional to the number of macromolecules.…”

Section: Discussionmentioning

confidence: 85%

“…41 The feasibility of using MT as an endogenous contrast mechanism to image the protein content of thrombus was demonstrated ex vivo using a catheter-based imaging MRI coil 28 and at high field. 30 Ex vivo measurement of the %MTR in human endarterectomy specimens showed that old (rich in protein debris) and recent (fibrin-rich) intraplaque hemorrhage had higher MTR compared with fresh intraplaque hemmorhage (rich in intact erythrocytes). 29 Similarly, ex vivo application of MT permitted the distinction between plateletrich and protein-rich thrombus in thrombosed rabbit plaque.…”

Section: Discussionmentioning

confidence: 96%

“…In vivo MT has been used to detect intracranial hemorrhage, 26,27 and ex vivo magnetization transfer contrast (MTC) showed the feasibility of visualizing regions of organized proteins in atherosclerosis 28,29 and thrombus associated with plaque rupture. 30 DW imaging (DWI) detected thrombus, [31][32][33][34] and calculation of the apparent diffusion coefficient (ADC) in vitro reflected the stages of thrombus aging and organization. 35 The protein content of thrombus and the diffusivity of water molecules depend on the local tissue microenvironment.…”

Section: Clinical Perspective On P 440mentioning

confidence: 99%

“…30 Ex vivo measurement of the %MTR in human endarterectomy specimens showed that old (rich in protein debris) and recent (fibrin-rich) intraplaque hemorrhage had higher MTR compared with fresh intraplaque hemmorhage (rich in intact erythrocytes). 29 Similarly, ex vivo application of MT permitted the distinction between plateletrich and protein-rich thrombus in thrombosed rabbit plaque.…”

mentioning

confidence: 96%

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In Vivo Magnetization Transfer and Diffusion-Weighted Magnetic Resonance Imaging Detects Thrombus Composition in a Mouse Model of Deep Vein Thrombosis

Phinikaridou

Andía

Saha

et al. 2013

Circ: Cardiovascular Imaging

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Deep vein thrombosis (DVT) remains a significant cause of morbidity and mortality despite the improvements in diagnosis and treatment. Approximately 30% of patients with DVT develop pulmonary embolism, of whom 10% die, and 50% of patients with DVT develop long-term sequelae like the postthrombotic syndrome. 1,2 Clinical Perspective on p 440Treatment of DVT is usually achieved with anticoagulation (heparin, warfarin) or thrombolysis (plasminogen activators). Anticoagulants prevent thrombus expansion but have little effect on thrombus resolution, which occurs slowly through a natural process of organization that eventually leads to recanalization of the vein. 1,3,4 Thrombolytic agents rapidly remove the thrombus, aiding faster vein recanalization, with less thrombus recurrence and fewer postthrombotic complications.5 Systemic thrombolysis is, however, associated with serious complications, including bleeding and pulmonary emboli. Selection criteria for identifying patients who might benefit from thrombolytic treatment are based on a subjective assessment of patient history. [5][6][7] Catheter-directed thrombolysis has reduced the rate of complications, but the time interval between the onset of symptoms and effective thrombolysis is still unclear. Several studies have shown that thrombolysis might be ineffective if administered 10 to 21 days after the onset of symptoms. [8][9][10] Fibrin-rich thrombus seems to be more amenable to thrombolysis, and incorporation of collagen into a fibrin clot dramatically decreases the effectiveness of fibrinolysis in experimental models. 11,12 Identification of the extracellular protein milieu and structural microenvironment of the thrombus might therefore provide important prognostic information on its lysability.Background-Deep vein thrombosis remains a major health problem necessitating accurate diagnosis. Thrombolysis is associated with significant morbidity and is effective only for the treatment of unorganized thrombus. We tested the feasibility of in vivo magnetization transfer (MT) and diffusion-weighted magnetic resonance imaging to detect thrombus organization in a murine model of deep vein thrombosis. Methods and Results-Deep vein thrombosis was induced in the inferior vena cava of male BALB/C mice. Magnetic resonance imaging was performed at days 1, 7, 14, 21, and 28 after thrombus induction using MT, diffusion-weighted, inversion-recovery, and T1-mapping protocols. Delayed enhancement and T1 mapping were repeated 2 hours after injection of a fibrin contrast agent. Finally, excised thrombi were used for histology. We found that MT and diffusion-weighted imaging can detect histological changes associated with thrombus aging. MT rate (MTR) maps and percentage of MT rate (%MTR) allowed visualization and quantification of the thrombus protein content, respectively. The %MTR increased with thrombus organization and was significantly higher at days 14, 21, and 28 after thrombus induction (days 1, Ultrasound examination, used in the diagnosis of DVT, provides only information...

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 96%

Section: Clinical Perspective On P 440mentioning

confidence: 99%

mentioning

confidence: 96%

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In Vivo Magnetization Transfer and Diffusion-Weighted Magnetic Resonance Imaging Detects Thrombus Composition in a Mouse Model of Deep Vein Thrombosis

Phinikaridou

Andía

Saha

et al. 2013

Circ: Cardiovascular Imaging

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“…Compared with CUS, MRI can detect pelvic DVT and can more precisely define proximal (popliteal vein and above) and distal leg (below popliteal vein) DVT 8 , to better assess the risk of PE. MRI can characterize thrombus age and organization, and may help differentiate acute from chronic DVT [9][10][11] (refs updated). Quantification of thrombus volume, an important metric to assess the disease evolution and response to treatment, is feasible with MR imaging.…”

Section: Introductionmentioning

confidence: 99%

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

Mani

Alie

Ramachandran

et al. 2015

JoVE

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We evaluated a magnetic resonance venography (MRV) approach with gadofosveset to quantify total thrombus volume changes as the principal criterion for treatment efficacy in a multicenter randomized study comparing edoxaban monotherapy with a heparin/warfarin regimen for acute, symptomatic lower extremities deep vein thrombosis (DVT) treatment. We also used a direct thrombus imaging approach (DTHI, without the use of a contrast agent) to quantify fresh thrombus. We then sought to evaluate the reproducibility of the analysis methodology and applicability of using 3D magnetic resonance venography and direct thrombus imaging for the quantification of DVT in a multicenter trial setting. From 10 randomly selected subjects participating in the edoxaban Thrombus Reduction Imaging Study (eTRIS), total thrombus volume in the entire lower extremity deep venous system was quantified bilaterally. Subjects were imaged using 3D-T1W gradient echo sequences before (direct thrombus imaging, DTHI) and 5 min after injection of 0.03 mmol/kg of gadofosveset trisodium (magnetic resonance venography, MRV). The margins of the DVT on corresponding axial, curved multi-planar reformatted images were manually delineated by two observers to obtain volumetric measurements of the venous thrombi. MRV was used to compute total DVT volume, whereas DTHI was used to compute volume of fresh thrombus. Intra-class correlation (ICC) and Bland Altman analysis were performed to compare inter and intra-observer variability of the analysis. The ICC for inter and intra-observer variability was excellent (0.99 and 0.98, p <0.001, respectively) with no bias on Bland-Altman analysis for MRV images. For DTHI images, the results were slightly lower (ICC = 0.88 and 0.95 respectively, p <0.001), with bias for inter-observer results on Bland-Altman plots. This study showed feasibility of thrombus volume estimation in DVT using MRV with gadofosveset trisodium, with good intra-and inter-observer reproducibility in a multicenter setting. Video LinkThe video component of this article can be found at

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A dual flip angle 3D bSSFP magnetization transfer‐like method to differentiate between recent and old myocardial infarction

Germain

Ghannudi

Labani

et al. 2017

Magnetic Resonance Imaging

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Detection of thrombus size and protein content by ex vivo magnetization transfer and diffusion weighted MRI

Cited by 16 publications

References 55 publications

In Vivo Magnetization Transfer and Diffusion-Weighted Magnetic Resonance Imaging Detects Thrombus Composition in a Mouse Model of Deep Vein Thrombosis

In Vivo Magnetization Transfer and Diffusion-Weighted Magnetic Resonance Imaging Detects Thrombus Composition in a Mouse Model of Deep Vein Thrombosis

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

A dual flip angle 3D bSSFP magnetization transfer‐like method to differentiate between recent and old myocardial infarction

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