Detection of thrombus by using phase-image MR scans: ROC curve analysis

Spin-echo phase images have been shown to be sensitive to blood flow and have been used to differentiate slow flow from thrombus, with an apparent advantage in comparison with spin-echo intensity images alone. In order to quantify the diagnostic efficacy of phase images, a study was performed comparing the sensitivity and specificity of MR imaging in identifying intravascular thrombus using spin-echo magnitude images alone and combined with phase images. In 45 subjects, 66 vessels with questionable intraluminal signal were reviewed in a blinded manner by four radiologists using seven levels of certitude for the diagnosis of thrombus. Vessels in the thorax, abdomen, and pelvis were included in the evaluation and were selected on the basis of the presence of intraluminal signal, which raised the possibility of intravascular disease. Corroborative studies were available in all cases. Receiver-operator-characteristic curves were constructed for the accuracy of the decision of intraluminal thrombus vs flow signal when using magnitude images alone and when using magnitude plus phase images. Magnitude images identified thrombus with a sensitivity of 35% at a specificity of 90%. On the other hand, combining magnitude image and phase images yielded sensitivities of 85% and 83% at specificities of 90% and 95%, respectively. We conclude that addition of phase images substantially increases the level of confidence in detecting intravascular thrombosis.