OBJECTIVE: Left atrial thrombi are an important cause for embolism-related morbidity and mortality. Transesophageal echocardiography (TEE), the clinical reference, is semiinvasive; thus, we aimed to assess the value of contrast-enhanced cardiovascular MRI for the detection of thrombus in the left atrial appendage. CONCLUSION: The image quality was good for both 2D perfusion (grade 4 +/- 1) and 3D turbo fast low-angle shot (FLASH) (grade 4 +/- 1, n.s.). Compared with TEE, 2D perfusion, 3D turboFLASH, and the combination of both techniques yielded sensitivities of 47/35/44%, specificities of 50/67/67%, positive predictive values of 73/75/80%, and negative predictive values of 25/27/29%, respectively. The size of the thrombus was overestimated by 2D perfusion (66%) and by 3D turboFLASH (25%) and agreement for location and shape of thrombus was 50% and 75% for 2D perfusion and 75% and 50% for 3D turboFLASH, respectively. The TEE thrombus size was significantly larger in patients with true-positive diagnoses by 2D perfusion (148%) and by 3D turboFLASH (151%) when compared with patients with false-negative diagnoses (p < 0.05 for both). No such difference was found for image quality, time delay between TEE and MRI examination, and location and shape of thrombi. Contrast-enhanced MRI lacks diagnostic accuracy for the detection of thrombi in the left atrial appendage. Future technical improvements are essential to establish this technique as a noninvasive alternative to TEE.
OBJECTIVE:Left atrial thrombi are an important cause for embolism-related morbidity and mortality. Transesophageal echocardiography (TEE), the clinical reference, is semiinvasive; thus, we aimed to assess the value of contrast-enhanced cardiovascular MRI for the detection of thrombus in the left atrial appendage. CONCLUSION: The image quality was good for both 2D perfusion (grade 4 +/- 1) and 3D turbo fast low-angle shot (FLASH) (grade 4 +/- 1, n.s.). Compared with TEE, 2D perfusion, 3D turboFLASH, and the combination of both techniques yielded sensitivities of 47/35/44%, specificities of 50/67/67%, positive predictive values of 73/75/80%, and negative predictive values of 25/27/29%, respectively. The size of the thrombus was overestimated by 2D perfusion (66%) and by 3D turboFLASH (25%) and agreement for location and shape of thrombus was 50% and 75% for 2D perfusion and 75% and 50% for 3D turboFLASH, respectively. The TEE thrombus size was significantly larger in patients with true-positive diagnoses by 2D perfusion (148%) and by 3D turboFLASH (151%) when compared with patients with false-negative diagnoses (p < 0.05 for both). No such difference was found for image quality, time delay between TEE and MRI examination, and location and shape of thrombi. Contrast-enhanced MRI lacks diagnostic accuracy for the detection of thrombi in the left atrial appendage. Future technical improvements are essential to establish this technique as a noninvasive alternative to TEE.
Authors: W Gregory Hundley; David A Bluemke; J Paul Finn; Scott D Flamm; Mark A Fogel; Matthias G Friedrich; Vincent B Ho; Michael Jerosch-Herold; Christopher M Kramer; Warren J Manning; Manesh Patel; Gerald M Pohost; Arthur E Stillman; Richard D White; Pamela K Woodard Journal: Circulation Date: 2010-05-17 Impact factor: 29.690
Authors: W Gregory Hundley; David A Bluemke; J Paul Finn; Scott D Flamm; Mark A Fogel; Matthias G Friedrich; Vincent B Ho; Michael Jerosch-Herold; Christopher M Kramer; Warren J Manning; Manesh Patel; Gerald M Pohost; Arthur E Stillman; Richard D White; Pamela K Woodard Journal: J Am Coll Cardiol Date: 2010-06-08 Impact factor: 24.094
Authors: E Di Cesare; F Cademartiri; I Carbone; A Carriero; M Centonze; F De Cobelli; R De Rosa; P Di Renzi; A Esposito; R Faletti; R Fattori; M Francone; A Giovagnoni; L La Grutta; G Ligabue; L Lovato; R Marano; M Midiri; A Romagnoli; V Russo; F Sardanelli; L Natale; J Bogaert; A De Roos Journal: Radiol Med Date: 2012-11-26 Impact factor: 3.469
Authors: Oliver K Mohrs; Thomas Voigtlaender; Steffen E Petersen; Matthias Zander; Thomas Schulze; Anselm Pottmeyer; Hans-Ulrich Kauczor Journal: Eur Radiol Date: 2008-03-15 Impact factor: 5.315