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Updated: May 24, 2026

Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Left ventricular thrombus attenuation characterization in cardiac computed tomography angiography
Márcio Sommer Bittencourt1, Stephan Achenbach, Mohamed Marwan
1Internal Medicine Division, University Hospital, University of São Paulo Medical School, Av. Lineu Prestes 2565, CEP: 05508-000, Butanta, Sao Paulo, Brazil. msbittencourt@bol.com.br
Left ventricular thrombi have lower CT attenuation than the myocardial wall, aiding differentiation in contrast-enhanced coronary CT angiography. This measurement helps distinguish thrombi from heart muscle tissue.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Differentiating left ventricular thrombi from the myocardial wall in contrast-enhanced coronary computed tomography (CT) angiography is challenging due to similar visual appearances.
- Accurate identification is crucial for appropriate patient management and treatment strategies.
Purpose of the Study:
- To establish typical CT attenuation values for left ventricular thrombi.
- To determine the utility of CT attenuation measurements in differentiating thrombi from myocardial tissue.
Main Methods:
- Retrospective analysis of 31 patients with left ventricular thrombi identified on CT angiography over 6 years.
- Assessment of CT attenuation (Hounsfield units) of thrombi, ascending aorta, left ventricle, and myocardial walls.
- Calculation of mean attenuation values, differences, and ratios between these structures.
Main Results:
- Mean CT attenuation of left ventricular thrombi was 43.2 ± 15.3 HU, significantly lower than myocardial walls (septal: 102.9 ± 23.1 HU; lateral: 99.3 ± 28.7 HU).
- A CT attenuation threshold of 65 HU demonstrated high diagnostic performance (94-97%) for differentiating thrombi from myocardium.
- Ratios of thrombus-to-aorta attenuation were significantly lower than myocardium-to-aorta ratios.
Conclusions:
- CT attenuation is a valuable quantitative parameter for differentiating left ventricular thrombi from the myocardial wall in CT angiography.
- Lower CT attenuation values within thrombi compared to myocardium can improve diagnostic accuracy.
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