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Updated: Feb 22, 2026

Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Added value of multiphase CTA imaging for thrombus perviousness assessment
E M M Santos1,2, C D d'Esterre3, K M Treurniet4
1Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands.
Dynamic CT angiography (CTA) does not improve thrombus perviousness assessment in acute ischemic stroke (AIS). Arterial-phase CTA is optimal for predicting favorable outcomes, highlighting contrast arrival delay as a key factor.
Area of Science:
- Neuroradiology
- Medical Imaging
- Stroke Research
Background:
- Thrombus perviousness is linked to better functional outcomes in acute ischemic stroke (AIS) patients.
- Conventional computed tomography angiography (CTA) may underestimate thrombus perviousness due to contrast arrival delays.
- Dynamic CTA sequences offer a potential solution to overcome imaging delays in assessing thrombus characteristics.
Purpose of the Study:
- To evaluate the added value of dynamic CTA in assessing thrombus perviousness.
- To investigate the association between thrombus attenuation increase (TAI) across different CTA phases and functional outcomes in AIS patients.
Main Methods:
- A prospective study included 221 AIS patients with anterior or posterior circulation occlusions.
- Multi-phase CTA (MCTA) and time-invariant CTA (TiCTA) were used to measure thrombus attenuation increase (TAI).
- Associations between TAI and favorable 90-day functional outcomes (mRS ≤ 2) were analyzed using regression models and AUC.
Main Results:
- TAI measured during the arterial phase of MCTA showed the strongest association with favorable outcomes (OR=1.21, AUC=0.62).
- Other phases (venous, delayed) and TiCTA demonstrated weaker associations with functional outcomes.
- In multivariable analysis, only arterial-phase TAI remained significantly associated with favorable outcomes (aOR=1.59).
Conclusions:
- Arterial-phase CTA provides optimal assessment of thrombus perviousness and its association with functional outcomes in AIS.
- Dynamic CTA imaging offers no additional benefit over arterial-phase CTA for current thrombus perviousness evaluation.
- The delay in contrast arrival at the thrombus is a critical determinant of patient functional outcome.
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