Mollet Nico R, Dymarkowski Steven, Volders Wim, Wathiong Jurgen, Herbots Lieven, Rademakers Frank E, Bogaert Jan
Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium.
Circulation. 2002 Dec 3;106(23):2873-6. doi: 10.1161/01.cir.0000044389.51236.91.
Ventricular thrombus formation is a frequent and potentially dangerous complication in patients with ischemic heart disease. Although transthoracic echocardiography (TTE) is generally used as diagnostic technique, we explored the role of contrast-enhanced (CE)-MRI to detect ventricular thrombi.
In 57 patients with acute myocardial infarction, chronic myocardial infarction, or ischemic cardiomyopathy, MRI was performed to evaluate ventricular function (CINE-MRI) and to depict presence of myocardial necrosis and/or scarring and no-reflow areas (CE-MRI). All studies were analyzed for concomitant ventricular thrombi. CE-MRI depicted 12 mural thrombi (3.1+/-2.9 cm3), located in left ventricular (LV) apex or adherent to anteroseptum, presenting as black, well-defined structures surrounded by bright contrast-enhanced blood. Thrombus formation on CE-MRI was related to larger end-diastolic volumes; lower ejection fractions; the region of delayed enhancement and lowest wall motion score, especially in left anterior descending coronary artery territory; and LV aneurysm formation. On CINE-MRI, thrombi were found in 6 patients. Nonvisualized thrombi were usually small (mean size 1.2+/-0.7 cm3). TTE depicted thrombi in 5. Nonvisualized lesions were most frequently located in LV apex and had a larger size than nonvisualized lesions on CINE-MRI (3.0+/-3.2 cm3). In 3 patients with suspected apical thrombus on TTE, MRI was normal.
CE-MRI is not only an excellent technique to depict myocardial necrosis and scar tissue in patients with ischemic heart disease, but this study also suggests a better identification of LV thrombi than with presently used clinical imaging modalities, such as TTE.
心室血栓形成是缺血性心脏病患者常见且具有潜在危险的并发症。尽管经胸超声心动图（TTE）通常用作诊断技术，但我们探讨了对比增强（CE）-MRI在检测心室血栓中的作用。
对57例急性心肌梗死、慢性心肌梗死或缺血性心肌病患者进行MRI检查，以评估心室功能（电影MRI）并描绘心肌坏死和/或瘢痕形成以及无复流区域（CE-MRI）。对所有研究进行分析以确定是否存在合并的心室血栓。CE-MRI显示12个壁血栓（体积为3.1±2.9 cm³），位于左心室心尖或附着于前间隔，表现为黑色、边界清晰的结构，周围为对比增强的明亮血液。CE-MRI上血栓形成与更大的舒张末期容积、更低的射血分数、延迟强化区域和最低的壁运动评分有关，尤其是在左前降支冠状动脉供血区域，还与左心室室壁瘤形成有关。在电影MRI上，6例患者发现有血栓。未显示的血栓通常较小（平均大小为1.2±0.7 cm³）。TTE显示5例有血栓。未显示的病变最常见于左心室心尖，且比电影MRI上未显示的病变更大（3.0±3.2 cm³）。在3例TTE怀疑有心尖血栓的患者中，MRI检查结果正常。
CE-MRI不仅是描绘缺血性心脏病患者心肌坏死和瘢痕组织的优秀技术，而且本研究还表明，与目前使用的临床成像方式如TTE相比，CE-MRI能更好地识别左心室血栓。
