Cardiovascular magnetic resonance black-blood thrombus imaging for the diagnosis of acute deep vein thrombosis at 1.5 Tesla

Hanwei Chen, Xueping He, Guoxi Xie, Jianke Liang, Yufeng Ye, Wei Deng, Zhuonan He, Dexiang Liu, Debiao Li, Xin Liu, Zhaoyang Fan, Hanwei Chen, Xueping He, Guoxi Xie, Jianke Liang, Yufeng Ye, Wei Deng, Zhuonan He, Dexiang Liu, Debiao Li, Xin Liu, Zhaoyang Fan

Abstract

Background: The aim was to investigate the feasibility of a cardiovascular magnetic resonance (CMR) black-blood thrombus imaging (BBTI) technique, based on delay alternating with nutation for tailored excitation black-blood preparation and a variable flip angle turbo-spin-echo readout, for the diagnosis of acute deep vein thrombosis (DVT) at 1.5 T.

Methods: BBTI was conducted in 15 healthy subjects and 30 acute DVT patients. Contrast-enhanced CMR venography (CE-CMRV) was conducted for comparison and only performed in the patients. Apparent contrast-to-noise ratios between the thrombus and the muscle/lumen were calculated to determine whether BBTI could provide an adequate thrombus signal for diagnosis. Two blinded readers assessed the randomized BBTI images from all participants and made independent decisions on the presence or absence of thrombus at the segment level. Images obtained by CE-CMRV were also randomized and assessed by the two readers. Using the consensus CE-CMRV as a reference, the sensitivity, specificity, positive and negative predictive values, and accuracy of BBTI, as well as its diagnostic agreement with CE-CMRV, were calculated. Additionally, diagnostic confidence and interobserver diagnostic agreement were evaluated.

Results: The thrombi in the acute phase exhibited iso- or hyperintense signals on the BBTI images. All the healthy subjects were correctly identified from the participants based on the segment level. The diagnostic confidence of BBTI was comparable to that of CE-CMRV (3.69 ± 0.52 vs. 3.70 ± 0.47). High overall sensitivity (95.2%), SP (98.6%), positive predictive value (96.0%), negative predictive value (98.3%), and accuracy (97.7%), as well as excellent diagnostic and interobserver agreements, were achieved using BBTI.

Conclusion: BBTI is a reliable, contrast-free technique for the diagnosis of acute DVT at 1.5 T.

Keywords: Deep vein thrombosis; Magnetic resonance imaging; Venography; Venous thrombosis.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional review boards of the Guangzhou Panyu Central Hospital (K20150030 and H20170024). In addition, informed consent was obtained from all the participants.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Representative images obtained by contrast-enhanced cardiovascular magnetic resonance (CE-CMRV) and black blood thrombus imaging (BBTI) from a 55-year-old woman with deep venous thrombosis (DVT) symptom onset at 5 days. The thrombus detected by BBTI showed iso-intense signals within the black-blood venous lumen. The locations and sizes of the thrombi between BBTI and CE-CMRV matched (yellow arrows)
Fig. 2
Fig. 2
Representative images obtained by CE-CMRV and BBTI from a 68-year-old woman with DVT symptom onset at 8 days. The thrombus detected by BBTI showed iso- and hyperintense signals within the black-blood venous lumen. The locations and sizes of the thrombi between BBTI and CE-CMRV matched (yellow arrows)
Fig. 3
Fig. 3
Representative images obtained by CE-CMRV and BBTI from a patient with DVT symptom onset at 10 days. The small thrombus can also be detected by BBTI and matched well with that seen with CE-CMRV (yellow arrows)
Fig. 4
Fig. 4
Results of quantitative signal to noise (SNR) and contrast to noise (CNR) analysis. Both iso−/hyperintense thrombi had adequate signal intensity and contrast to the black-blood venous lumen for the diagnosis of DVT
Fig. 5
Fig. 5
Volume percentage of the iso-intense thrombus in total thrombus volume of each patient. According to the linear regression analysis, the volume percentage of the iso-intense thrombus decreases with the duration of symptoms, indicating that the thrombus signal intensity tends to become stronger
Fig. 6
Fig. 6
Example images obtained in 50-year-old woman with DVT symptom onset at 3 days. The thrombus (green arrows) was detected by BBTI at the asymptomatic right leg, which was missed by the initial ultrasound and confirmed by CE-CMRV. Most parts of the thrombi (yellow arrows) appeared as isointense signals on the BBTI images. The locations and sizes of the thrombi between BBTI and CE-CMRV matched

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