Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction

C. H.P. Jansen, D. Perera, M. R. Makowski, A. J. Wiethoff, A. Phinikaridou, R. M. Razavi, M. S. Marber, G. F. Greil, E. Nagel, D. Maintz, S. Redwood, R. M. Botnar

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Abstract

Bacground-: Persistent intracoronary thrombus after plaque rupture is associated with an increased risk of subsequent myocardial infarction and mortality. Coronary thrombus is usually visualized invasively by x-ray coronary angiography. Non-contrast-enhanced T1-weighted magnetic resonance (MR) imaging has been useful for direct imaging of carotid thrombus and intraplaque hemorrhage by taking advantage of the short T1 of methemoglobin present in acute thrombus and intraplaque hemorrhage. The aim of this study was to investigate the use of non-contrast-enhanced MR for direct thrombus imaging (MRDTI) in patients with acute myocardial infarction. Methods and Results-: Eighteen patients (14 men; age, 61±9 years) underwent MRDTI within 24 to 72 hours of presenting with an acute coronary syndrome before invasive x-ray coronary angiography; MRDTI was performed with a T1-weighted, 3-dimensional, inversion-recovery black-blood gradient-echo sequence without contrast administration. Ten patients were found to have intracoronary thrombus on x-ray coronary angiography (left anterior descending, 4; left circumflex, 2; right coronary artery, 4; and right coronary artery-posterior descending artery, 1), and 8 had no visible thrombus. We found that MRDTI correctly identified thrombus in 9 of 10 patients (sensitivity, 91%; posterior descending artery thrombus not detected) and correctly classified the control group in 7 of 8 patients without thrombus formation (specificity, 88%). The contrast-to-noise ratio was significantly greater in coronary segments containing thrombus (n=10) compared with those without visible thrombus (n=131; mean contrast-to-noise ratio, 15.9 versus 2.6; P<0.001). Conclusion-: Use of MRDTI allows selective visualization of coronary thrombus in a patient population with a high probability of intracoronary thrombosis.

Original languageEnglish (US)
Pages (from-to)416-424
Number of pages9
JournalCirculation
Volume124
Issue number4
DOIs
StatePublished - Jul 26 2011

Fingerprint

Thrombosis
Myocardial Infarction
Magnetic Resonance Imaging
Coronary Angiography
X-Rays
Noise
Coronary Vessels
Arteries
Hemorrhage
Methemoglobin
Acute Coronary Syndrome
Rupture
Magnetic Resonance Spectroscopy

Keywords

  • atherosclerosis
  • coronary artery disease
  • magnetic resonance imaging
  • myocardial infarction
  • thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Jansen, C. H. P., Perera, D., Makowski, M. R., Wiethoff, A. J., Phinikaridou, A., Razavi, R. M., ... Botnar, R. M. (2011). Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction. Circulation, 124(4), 416-424. https://doi.org/10.1161/CIRCULATIONAHA.110.965442

Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction. / Jansen, C. H.P.; Perera, D.; Makowski, M. R.; Wiethoff, A. J.; Phinikaridou, A.; Razavi, R. M.; Marber, M. S.; Greil, G. F.; Nagel, E.; Maintz, D.; Redwood, S.; Botnar, R. M.

In: Circulation, Vol. 124, No. 4, 26.07.2011, p. 416-424.

Research output: Contribution to journalArticle

Jansen, CHP, Perera, D, Makowski, MR, Wiethoff, AJ, Phinikaridou, A, Razavi, RM, Marber, MS, Greil, GF, Nagel, E, Maintz, D, Redwood, S & Botnar, RM 2011, 'Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction', Circulation, vol. 124, no. 4, pp. 416-424. https://doi.org/10.1161/CIRCULATIONAHA.110.965442
Jansen, C. H.P. ; Perera, D. ; Makowski, M. R. ; Wiethoff, A. J. ; Phinikaridou, A. ; Razavi, R. M. ; Marber, M. S. ; Greil, G. F. ; Nagel, E. ; Maintz, D. ; Redwood, S. ; Botnar, R. M. / Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction. In: Circulation. 2011 ; Vol. 124, No. 4. pp. 416-424.
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abstract = "Bacground-: Persistent intracoronary thrombus after plaque rupture is associated with an increased risk of subsequent myocardial infarction and mortality. Coronary thrombus is usually visualized invasively by x-ray coronary angiography. Non-contrast-enhanced T1-weighted magnetic resonance (MR) imaging has been useful for direct imaging of carotid thrombus and intraplaque hemorrhage by taking advantage of the short T1 of methemoglobin present in acute thrombus and intraplaque hemorrhage. The aim of this study was to investigate the use of non-contrast-enhanced MR for direct thrombus imaging (MRDTI) in patients with acute myocardial infarction. Methods and Results-: Eighteen patients (14 men; age, 61±9 years) underwent MRDTI within 24 to 72 hours of presenting with an acute coronary syndrome before invasive x-ray coronary angiography; MRDTI was performed with a T1-weighted, 3-dimensional, inversion-recovery black-blood gradient-echo sequence without contrast administration. Ten patients were found to have intracoronary thrombus on x-ray coronary angiography (left anterior descending, 4; left circumflex, 2; right coronary artery, 4; and right coronary artery-posterior descending artery, 1), and 8 had no visible thrombus. We found that MRDTI correctly identified thrombus in 9 of 10 patients (sensitivity, 91{\%}; posterior descending artery thrombus not detected) and correctly classified the control group in 7 of 8 patients without thrombus formation (specificity, 88{\%}). The contrast-to-noise ratio was significantly greater in coronary segments containing thrombus (n=10) compared with those without visible thrombus (n=131; mean contrast-to-noise ratio, 15.9 versus 2.6; P<0.001). Conclusion-: Use of MRDTI allows selective visualization of coronary thrombus in a patient population with a high probability of intracoronary thrombosis.",
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AU - Perera, D.

AU - Makowski, M. R.

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AU - Phinikaridou, A.

AU - Razavi, R. M.

AU - Marber, M. S.

AU - Greil, G. F.

AU - Nagel, E.

AU - Maintz, D.

AU - Redwood, S.

AU - Botnar, R. M.

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