Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg

Abstract

Summary. Background: Accurate diagnosis of acute recurrent deep vein thrombosis (DVT) is relevant to avoid improper diagnosis and unnecessary life‐long anticoagulant treatment. Compression ultrasound has high accuracy for a first episode of DVT, but is often unreliable in suspected recurrent disease. Magnetic resonance direct thrombus imaging (MR DTI) has been shown to accurately detect acute DVT. The purpose of this prospective study was to determine the MR signal change during 6 months follow‐up in patients with acute DVT. Patients/methods: This study was a prospective study of 43 consecutive patients with a first episode of acute DVT demonstrated by compression ultrasound. All patients underwent MR DTI. Follow‐up was performed with MR‐DTI and compression ultrasound at 3 and 6 months respectively. All data were coded, stored and assessed by two blinded observers. Results: MR direct thrombus imaging identified acute DVT in 41 of 43 patients (sensitivity 95%). There was no abnormal MR‐signal in controls, or in the contralateral extremity of patients with DVT (specificity 100%). In none of the 39 patients available at 6 months follow‐up was the abnormal MR‐signal at the initial acute DVT observed, whereas in 12 of these patients (30.8%) compression ultrasound was still abnormal. Conclusion: Magnetic resonance direct thrombus imaging normalizes over a period of 6 months in all patients with diagnosed DVT, while compression ultrasound remains abnormal in a third of these patients. MR‐DTI may potentially allow for accurate detection in patients with acute suspected recurrent DVT, and this should be studied prospectively.

Advanced imaging in acute and chronic deep vein thrombosis

“…The sensitivity of MRDTI was 95% and specificity was 100% (73,74). MRDTI is an accurate and reproducible method for distinguishing acute ipsilateral recurrent DVT © Cardiovascular Diagnosis and Therapy.…”

“…Limitations include that acute DVT can be missed in very early stages when the compression US may still detect incompletely compressible vein (74) as it needs certain amount of time for transformation of haemoglobin into sufficient amount of methemoglobin to cause T1 shortening mandatory for detection.…”

Diagnosis of DVT

“…181 However, there has been no evaluation of this technique's accuracy in patients with suspected recurrent DVT. MR venography has not been evaluated in patients with suspected DVT.…”

Visualization of deep veins and detection of deep vein thrombosis (DVT) with balanced turbo field echo (b‐TFE) and contrast‐enhanced T1 fast field echo (CE‐FFE) using a blood pool agent (BPA)

“…Four patients had DVT of the right limb, and mean symptom duration was 8.3 days (range, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Figure 3 shows examples of patients with DVT and direct and indirect findings of venous thrombosis in calf, knee, and thigh in corresponding images of the two MRI techniques.…”

“…Another problem is diagnostic imaging in patients presenting with recurrent, acute, or chronic DVT. These challenges can be overcome by use of MRI (2)(3)(4). Finally, MRI may provide valuable additional diagnostic information and establish differential diagnoses since this method also visualizes adjacent soft tissues and other vessels; i.e., superficial veins and arteries.…”