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Thrombus detection in the left atrial appendage using contrast-enhanced MRI: a pilot study
Oliver K Mohrs1, Bernd Nowak, Steffen E Petersen
1Cardiovascular Center Bethanien (CCB), Im Pruefling 23, D-60389 Frankfurt/Main, Germany. o.mohrs@gmx.de
AJR. American Journal of Roentgenology
|December 17, 2005
Summary
Contrast-enhanced MRI is not accurate for detecting left atrial thrombi. Further technical advancements are needed to make MRI a viable noninvasive alternative to transesophageal echocardiography (TEE) for thrombus detection.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Left atrial thrombi are a significant cause of embolism-related morbidity and mortality.
- Transesophageal echocardiography (TEE) is the current clinical standard but is semi-invasive.
Purpose of the Study:
- To evaluate the diagnostic accuracy of contrast-enhanced cardiovascular magnetic resonance imaging (MRI) for detecting left atrial appendage thrombi.
Main Methods:
- Comparison of contrast-enhanced MRI (2D perfusion and 3D turboFLASH sequences) with TEE for thrombus detection.
- Assessment of sensitivity, specificity, positive predictive value, and negative predictive value.
- Evaluation of thrombus size, location, and shape agreement between MRI and TEE.
Main Results:
- MRI techniques showed limited sensitivity and specificity compared to TEE.
- Thrombus size was frequently overestimated by MRI.
- Agreement on thrombus location and shape was suboptimal between MRI and TEE.
Conclusions:
- Contrast-enhanced MRI currently lacks the diagnostic accuracy for detecting left atrial thrombi.
- Technical improvements in MRI are necessary to establish it as a noninvasive alternative to TEE.