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Updated: Jan 22, 2026
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Elizabeth M Johnson1, Kenneth L Gage2, Sebastian Feuerlein2
1Department of Radiology, University of South Florida.
Insights
Cardiac magnetic resonance (CMR) protocols help identify cardiac thrombus by analyzing mass appearance and contrast enhancement. Emerging techniques like T1 mapping further support diagnosis, ensuring accurate patient care.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Cardiac masses require accurate differentiation from thrombi and tumors.
- Conventional cardiac magnetic resonance (CMR) protocols are established for evaluating suspected cardiac thrombus.
- Understanding the evolution of hemoglobin properties influences thrombus signal characteristics on MRI.
Purpose of the Study:
- To present the conventional CMR protocol for evaluating suspected cardiac thrombus.
- To highlight emerging techniques, including T1 mapping, for thrombus evaluation.
- To emphasize the importance of patient preparation and communication during CMR exams.
Main Methods:
- Utilizing specific magnetic resonance (MR) sequences to assess mass appearance.
- Analyzing T1 and T2 signal characteristics of cardiac masses.
- Evaluating contrast enhancement patterns post-administration.
- Incorporating T1 mapping as an emerging diagnostic tool.
Main Results:
- Thrombi exhibit distinct signal characteristics on T1 and T2 weighted images.
- A key differentiator is the lack of contrast enhancement in thrombi compared to tumors.
- T1 mapping provides additional diagnostic support for thrombus identification.
Conclusions:
- Optimal CMR protocols involve thorough patient screening, effective communication, and precise image acquisition.
- Post-processing and structured reporting are crucial for accurate diagnosis and communication of findings.
- Advanced techniques like T1 mapping enhance the diagnostic capability of CMR for cardiac thrombus.
Abstract:
We present the conventional cardiac magnetic resonance (CMR) protocol for evaluating a suspected thrombus and highlight emerging techniques. The appearance of a mass on certain magnetic resonance (MR) sequences can help differentiate a thrombus from competing diagnoses such as a tumor. T1 and T2 signal characteristics of a thrombus are related to the evolution of hemoglobin properties. A thrombus typically does not enhance following contrast administration, which also helps differentiation from a tumor. We also highlight the emerging role of T1 mapping in the evaluation of a thrombus, which can add another level of support in diagnosis. Prior to any CMR exam, patient screening and interviews are critical to ensure safety and to optimize patient comfort. Effective communication during the exam between the technologist and the patient promotes proper breath holding technique and higher quality images. Volumetric post processing and structured reporting are helpful to ensure that the radiologist answers the ordering services' question and communicates these results effectively. Optimal pre-MR safety evaluation, CMR exam execution, and post exam processing and reporting allow for delivery of high quality radiological service in the evaluation of a suspected cardiac thrombus.
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