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Multiparametric Contrast-Free MRI Successfully Identifies Venous Thrombus Responsive to Lytic Therapy: From Mice to
Justinas Silickas1, Alberto Smith1, Marcelo E Andia2,3,4
1School of Cardiovascular and Metabolic Medicine & Sciences (J.S., A.S., B.M., A.S.P., S.B.), Kings College London, UK.
Circulation. Cardiovascular Imaging
|November 3, 2025
Summary
Magnetic resonance-based multisequence thrombus imaging (MSTI) accurately predicts which deep venous thrombi are susceptible to thrombolysis. This contrast-free technique can guide patient selection for invasive therapies, improving treatment outcomes.
Area of Science:
- Vascular Medicine
- Medical Imaging
- Thrombosis Research
Background:
- Randomized trials for venous thrombolysis show inconsistent results for preventing postthrombotic syndrome.
- A method is needed to identify patients who will benefit most from interventional treatments.
- This study investigates a novel magnetic resonance-based multisequence thrombus imaging (MSTI) technique.
Purpose of the Study:
- To evaluate a contrast-free MSTI technique for characterizing deep venous thrombi.
- To predict the susceptibility of thrombi to thrombolysis using MSTI.
- To assess the potential of MSTI in guiding patient selection for thrombolytic therapy.
Main Methods:
- Venous thrombosis was induced in mice and imaged using a prelysis MSTI protocol (3D T1 mapping, 3D magnetization transfer, 2D diffusion-weighted imaging).
- Thrombolysis success was defined by a ≥50% increase in inferior vena cava blood flow post-treatment.
- A clinical cohort of patients with acute iliofemoral deep venous thrombi underwent MSTI prior to catheter-directed thrombolysis, with outcomes analyzed against imaging parameters.
Main Results:
- MSTI successfully identified thrombi susceptible to thrombolysis in both mice and humans.
- In mice, lysed thrombi had significantly lower T1 and higher apparent diffusion coefficient values compared to nonlysable thrombi.
- In patients, lysed thrombi showed lower T1 and apparent diffusion coefficient values, with similar magnetization transfer rates; combined MSTI parameters achieved high sensitivity and specificity in predicting thrombolysis success.
Conclusions:
- MSTI provides noninvasive, contrast-free characterization of thrombus composition.
- The technique accurately predicts thrombolytic susceptibility in deep venous thrombi.
- MSTI has the potential to guide patient selection for invasive therapies and should be integrated into future venous thrombosis treatment trials.
