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

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First pass perfusion imaging to improve the assessment of left ventricular thrombus following a myocardial infarction

Loïc Bière1, Martin Audonnet1, Guillaume Clerfond1

  • 1L'UNAM Université, Angers, France; Laboratoire de Cardioprotection, Remodelage et Thrombose, UPRES 3860, Service de Cardiologie, CHU d'Angers, Angers, France.

European Journal of Radiology
|August 10, 2016
PubMed

Insights

First-pass perfusion (FPP) sequences significantly improve the detection of left ventricular thrombus (LVT) in patients with ST-elevation myocardial infarction (STEMI). This cardiac MRI technique enhances diagnostic accuracy for both experts and novices, aiding in LVT identification.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Left ventricular thrombus (LVT) is a potential complication following myocardial infarction.
  • Accurate and timely detection of LVT is crucial for guiding treatment and preventing embolic events.

Purpose of the Study:

  • To evaluate the efficacy of first-pass perfusion (FPP) sequences in improving the detection rate of left ventricular thrombus (LVT) using cardiac magnetic resonance (CMR).

Main Methods:

  • Prospective study of 329 patients with first STEMI undergoing CMR at baseline and 3-month follow-up.
  • Two-step reading protocol: cine CMR and LGE (routine stage) followed by FPP sequence analysis.
  • Three blinded readers (2 experts, 1 novice) assessed LVT detection before and after FPP sequence integration.

Main Results:

  • LVT detected in 9.1% of patients (30/329), all in the left ventricular apex.
  • FPP significantly improved LVT detection for all readers, increasing diagnosis in 32-42% of suspected cases.
  • FPP enhanced novice sensitivity from 78.1% to 91.2%, with missed LVT cases reduced across all readers.

Conclusions:

  • The prevalence of LVT post-myocardial infarction is significant (9.1%).
  • First-pass perfusion (FPP) sequences enhance the diagnostic performance of cardiac MRI for LVT detection.
  • FPP improves diagnostic confidence for experienced readers and elevates the skill level of novice interpreters.
Abstract

Keywords:
Cardiac magnetic resonance imagingMyocardial infarctionPerfusion imagingThrombus

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