Three-Dimensional Black-Blood T1-Weighted Turbo Spin-Echo Techniques for the Diagnosis of Deep Vein Thrombosis in Comparison With Contrast-Enhanced Magnetic Resonance Imaging

Treitl, M; Treitl, Marcus; Kooijman-Kurfuerst, Hendrik; Kammer, Nora N.; Coppenrath, Eva; Suderland, Elena; Czihal, Michael; Hoffmann, Ulrich; Reiser, Maximilian; Saam, Tobias

doi:10.1097/rli.0000000000000142

Cited by 32 publications

(46 citation statements)

References 28 publications

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“…On MPRAGE, thrombus was identified as bright signal within the venous lumen that could be of neutral or low signal intensity relative to background tissues. Additionally, a diagnostic confidence score on a four-point scale as in Ttreitl et al [19] (1: poor; 4: excellent) was assigned to individual segments for each technique and then an average score was calculated for each subject.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, T1-weighted 3D variable flip angle turbo-spin-echo (SPACE) was proposed as a black-blood CMR approach to the detection of venous thrombosis [19, 20]. With the blood flow signal suppressed by the inherent black-blood effect of SPACE, this method can directly visualize the intraluminal thrombus.…”

Section: Introductionmentioning

confidence: 99%

“…With the blood flow signal suppressed by the inherent black-blood effect of SPACE, this method can directly visualize the intraluminal thrombus. However, because the venous blood flow can be tremendously slow in deep veins, especially when severe thrombosis is present, it could still be challenging for SPACE to achieve adequate suppression of flow signal that might otherwise become a confounder for thrombus identification [19]. On the other hand, flow signal suppression in SPACE imaging can be improved by using additional black-blood preparation - delay alternating with nutation for tailored excitation (DANTE) [21–24].…”

Section: Introductionmentioning

confidence: 99%

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Black-blood thrombus imaging (BTI): a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis

Xie

Chen

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundDeep 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.MethodsThis 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.ResultsBTI 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.ConclusionBTI 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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Black-blood thrombus imaging (BTI): a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis

Xie

Chen

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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“…For future studies of arterial dissection, 3D-T1w black-blood sequences such as 3D-T1w-VISTA or 3D-T1w-SPACE seem to be promising candidates as they provide superior coverage and sub-mm resolution. These sequences have already been applied successfully for thrombus imaging [18] and for vasculitis imaging [30]. Furthermore, we cannot provide histological proof that iCE represents thrombus formation which is due to the fact that histology is usually not obtained in sCAD patients.…”

Section: Limitationsmentioning

confidence: 84%

“…bb-MRI suppresses the signal of flowing blood which allows differentiation of the vessel wall and its components from the lumen, which appears dark. This technique has been used successfully for carotid plaque imaging [17], for the detection of venous thrombi [18] and for the visualization of CAD [13, 19 -21]. It has also been used successfully to image plaque rupture and local blood coagulation in carotid atherosclerotic plaques [12,17,18,22,23].…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Intraluminal Contrast Enhancement in Patients with Spontaneous Cervical Artery Dissection: A Black-Blood MRI Study

Coppenrath

Lenz

Sommer

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNGZiel Kürzlich durchgeführte Studien zeigten, dass intraluminale Thromben der A. carotis interna in black-blood (BB)-MRSequenzen eine Kontrastmittelaufnahme zeigen. Ziel der Studie ist es, die Wertigkeit der intraluminalen Kontrastmittelaufnahme bei Patienten mit einer spontanen arteriellen Dissektion der Halsgefäße zu untersuchen. Material und Methoden ABSTR AC TPurpose Recent studies have suggested that intraluminal thrombi show contrast enhancement on carotid black-blood T1w MRI. The aim of this study was to evaluate the significance of intraluminal contrast enhancement (iCE) regarding symptom status in patients with spontaneous cervical artery dissection (sCAD).Methods 33 consecutive patients (19 men) with sCAD received a brain MRI (DIFF, T2w, T2*w, FLAIR) and a multi-sequence 3T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre-and post-contrast, contrast-enhanced MR angiography and TOF images of carotid and vertebral arteries. Presence/absence of iCE, vessel occlusion and vessel wall hematoma (hyperintense in T1w pre-contrast) were analysed by two radiologists in consensus decision.Results 44 of 132 analysed vessels had a vessel wall hematoma, consistent with sCAD. In 17 of 44 dissected vessels an acute ischemic stroke was found. 16 of 17 (94.1 %) vessels ipsilateral to ischemic stroke demonstrated iCE, compared to 9 of 44 (20.4 %) dissected vessels without stroke (P< 0.001). The presence/absence of iCE resulted in a sensitivity, specificity, positive and negative predictive value and accuracy for ischemic stroke of 0. 94, 0.67, 0.64, 0.95, and 0.77, respectively, and an odds ratio of 32.0.Conclusion iCE, which is suggestive of intraluminal thrombus formation, is strongly correlated with ischemic symptoms in patients with sCAD. Key points▪ Intraluminal contrast enhancement is associated with cerebral ischemia in corresponding vessel territories in patients with cervical artery dissection. ▪ Our results suggest that intraluminal contrast enhancement represents intraluminal thrombus formation. ▪ Black-blood imaging might be useful to identify those patients with cervical artery dissection at higher risk for initial or recurrent stroke.

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Black‐Blood Contrast in Cardiovascular MRI

Henningsson

Malik

Botnar

et al. 2020

Magnetic Resonance Imaging

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MRI is a versatile technique that offers many different options for tissue contrast, including suppressing the blood signal, so‐called black‐blood contrast. This contrast mechanism is extremely useful to visualize the vessel wall with high conspicuity or for characterization of tissue adjacent to the blood pool. In this review we cover the physics of black‐blood contrast and different techniques to achieve blood suppression, from methods intrinsic to the imaging readout to magnetization preparation pulses that can be combined with arbitrary readouts, including flow‐dependent and flow‐independent techniques. We emphasize the technical challenges of black‐blood contrast that can depend on flow and motion conditions, additional contrast weighting mechanisms (T1, T2, etc.), magnetic properties of the tissue, and spatial coverage. Finally, we describe specific implementations of black‐blood contrast for different vascular beds. Level of Evidence 5 Technical Efficacy Stage 5

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Three-Dimensional Black-Blood T1-Weighted Turbo Spin-Echo Techniques for the Diagnosis of Deep Vein Thrombosis in Comparison With Contrast-Enhanced Magnetic Resonance Imaging

Cited by 32 publications

References 28 publications

Black-blood thrombus imaging (BTI): a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis

Black-blood thrombus imaging (BTI): a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis

Clinical Significance of Intraluminal Contrast Enhancement in Patients with Spontaneous Cervical Artery Dissection: A Black-Blood MRI Study

Black‐Blood Contrast in Cardiovascular MRI

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