Visualization of Ventricular Thrombi With Contrast-Enhanced Magnetic Resonance Imaging in Patients With Ischemic Heart Disease

Abstract

Background-Ventricular thrombus formation is a frequent and potentially dangerous complication in patients with ischemic heart disease. Although transthoracic echocardiography (TTE) is generally used as diagnostic technique, we explored the role of contrast-enhanced (CE)-MRI to detect ventricular thrombi. Methods and Results-In 57 patients with acute myocardial infarction, chronic myocardial infarction, or ischemic cardiomyopathy, MRI was performed to evaluate ventricular function (CINE-MRI) and to depict presence of myocardial necrosis and/or scarring and no-reflow areas (CE-MRI). All studies were analyzed for concomitant ventricular thrombi. CE-MRI depicted 12 mural thrombi (3.1Ϯ2.9 cm 3 ), located in left ventricular (LV) apex or adherent to anteroseptum, presenting as black, well-defined structures surrounded by bright contrast-enhanced blood. Thrombus formation on CE-MRI was related to larger end-diastolic volumes; lower ejection fractions; the region of delayed enhancement and lowest wall motion score, especially in left anterior descending coronary artery territory; and LV aneurysm formation. On CINE-MRI, thrombi were found in 6 patients. Nonvisualized thrombi were usually small (mean size 1.2Ϯ0.7 cm 3 ). TTE depicted thrombi in 5. Nonvisualized lesions were most frequently located in LV apex and had a larger size than nonvisualized lesions on CINE-MRI (3.0Ϯ3.2 cm 3 ). In 3 patients with suspected apical thrombus on TTE, MRI was normal. Conclusions-CE-MRI is not only an excellent technique to depict myocardial necrosis and scar tissue in patients withischemic heart disease, but this study also suggests a better identification of LV thrombi than with presently used clinical imaging modalities, such as TTE.

Detection of pericardial inflammation with late-enhancement cardiac magnetic resonance imaging: initial results

“…Furthermore, late-enhancement MRI may be used in a wider range of pathologies, including intra-cardiac thrombi, cardiomyopathies, myocarditis, cardiac masses and congenital heart disease [11][12][13][14][15]. The findings of the present study suggest that late-enhancement cardiac MRI can also be used to complement 'black-blood' spin-echo MRI in the assessment of the pericardium.…”

Major prognostic impact of persistent microvascular obstruction as assessed by contrast-enhanced cardiac magnetic resonance in reperfused acute myocardial infarction

“…Some areas were characterized by a persistent hypoenhanced area surrounded by hyperenhancement, reflecting PMO [13]. PMO was differentiated from mural thrombus by using criteria previously described [14]. PMO areas were visually interpreted as absent or present, and manually traced if present.…”

Delayed contrast–enhanced MRI: use in myocardial viability assessment and other cardiac pathology

“…9). In a recent study by Mollet et al, delayed contrast-enhanced MRI demonstrated significantly more ventricular thrombi in patients with ischemic heart disease than balanced-SSFP cine MRI and echocardiography [28]. This technique is definitely superior to detect small mural thrombi or thrombi trapped in endocardial trabeculations.…”