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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
06:29

Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques

Published on: June 11, 2019

Resolution of ventricular thrombus identified by contrast enhanced cardiac MRI

Joseph B Selvanayagam1, Nicos Spyrou, Jane M Francis

  • 1University of Oxford Centre for Clinical Magnetic Resonance Research, United Kingdom. joseph.selvanayagam@cardiov.ox.ac.uk

The International Journal of Cardiovascular Imaging
|March 16, 2005
PubMed

Insights

Cardiovascular magnetic resonance (CMR) effectively detected a left ventricular thrombus in a patient with LAD occlusion. Follow-up CMR confirmed complete thrombus resolution after warfarin therapy.

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Cardiac MRI

Background:

  • A 53-year-old male presented with a left anterior descending (LAD) artery occlusion, necessitating assessment of myocardial viability.
  • Initial echocardiography revealed mildly reduced global left ventricular function without other significant findings.

Observation:

  • Cardiovascular magnetic resonance (CMR) imaging demonstrated a dilated left ventricle with reduced ejection fraction (45%).
  • Significant findings included anteroapical wall akinesis, mid anteroseptal hypokinesis, and a prominent 1.4 cm left ventricular apical thrombus on post-gadolinium sequences.
  • Extensive transmural hyperenhancement was observed in the mid and apical septum and apex, indicating myocardial scar.

Findings:

  • A 4-month course of warfarin therapy led to the complete resolution of the left ventricular apical thrombus.
  • Serial CMR scans confirmed the absence of thrombus and resolution of associated imaging abnormalities post-treatment.

Implications:

  • Contrast-enhanced CMR is a highly sensitive method for diagnosing left ventricular thrombi.
  • CMR imaging offers advantages over 2D echocardiography, particularly in overcoming near-field limitations for thrombus detection.

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