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Updated: Aug 14, 2026
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Lysability of arterial thrombi assessed by magnetic resonance imaging
1Department of Vascular Diseases, University of Ljubljana Medical Centre, Ljubljana, Slovenia. matija.kozak@trnovo.kclj.si
Background:
Intravascular thrombi change in time due to retraction and organization, which is reflected in the appearance of magnetic resonance images of clots. We have hypothesized that MRI has the potential to improve patient selection for thrombolytic treatment. The aim of our study was to analyze occlusive arterial thrombi with MRI, and to correlate the MRI parameters with the therapeutic outcome in patients with occlusive atherothrombotic disease of the superficial femoral artery who were treated with catheter-directed thrombolysis by streptokinase.
Patients And Methods:
We included 13 patients with subacute (2 weeks to 3 months old) occlusive arterial thrombi and 4 patients with chronic (more than 6 months old) arterial occlusions. We measured the MRI signal intensity on gradient echo images of 98 axial slices of the subacute occlusive thrombi and in 45 slices of 4 chronic thrombi. Following MRI, the patients with subacute history were treated with catheter-directed thrombolysis.
Results:
Thrombolysis was successful in 11/13 patients. The normalized MRI signal intensity was significantly higher in the unsuccessfully treated thrombi than in the successfully treated thrombi (1.10 +/- 0.08 vs. 0.72 +/- 0.17, p < 0.003), but the subacute and chronic thrombi did not differ in signal intensity.
Conclusions:
High signal intensity of arterial thrombi on gradient echo MRI might predict resistance to thrombolytic therapy.
Insights
High MRI signal intensity in arterial thrombi may indicate resistance to thrombolytic therapy, potentially improving patient selection for treatments like streptokinase. This finding aids in predicting treatment success for occlusive arterial diseases.
Area of Science:
- Vascular Medicine
- Radiology
- Interventional Cardiology
Background:
- Intravascular thrombi evolve over time, altering their appearance on magnetic resonance imaging (MRI).
- MRI may enhance patient selection for thrombolytic therapy.
- This study investigated occlusive arterial thrombi in superficial femoral artery disease.
Purpose of the Study:
- To analyze arterial thrombi using MRI.
- To correlate MRI parameters with therapeutic outcomes.
- To evaluate catheter-directed thrombolysis with streptokinase.
Main Methods:
- Included 13 patients with subacute (2 weeks-3 months) and 4 with chronic (>6 months) arterial occlusions.
- Measured MRI signal intensity on gradient echo images of thrombi.
- Treated subacute thrombi with catheter-directed thrombolysis.
Main Results:
- Thrombolysis was successful in 11 out of 13 patients.
- Unsuccessfully treated thrombi showed significantly higher normalized MRI signal intensity (1.10 +/- 0.08) compared to successfully treated thrombi (0.72 +/- 0.17).
- No significant difference in signal intensity was observed between subacute and chronic thrombi.
Conclusions:
- High signal intensity on gradient echo MRI may predict resistance to thrombolytic therapy.
- This finding could aid in optimizing treatment strategies for arterial occlusive diseases.
