Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang Province 310016, China.
Chin Med J (Engl). 2012 Jun;125(11):1889-92.
An early identification of the composition of arterial thrombus may have diagnostic, therapeutic, and prognostic implications. The variation of magnetic resonance (MR) signal intensity between white and red thrombi, especially in the susceptibility sensitive MR sequence, remains unknown. Our research was to evaluate the feasibility of MRI in differentiating of white and red thrombi with a phantom study.
A total of 12 red and 12 white thrombi were prepared with the venous blood. Examination of the phantom was completed using a 3.0T MR unit, including fluid attenuated inversion recovery (FLAIR) T1, T2-weighted imaging (T2WI), FLAIR T2, T2 gradient echo (T2 GRE) imaging, and susceptibility weighted angiography sequences (SWAN). MR signal intensity patterns of the thrombi were objectively classified as hyperintensity, isointensity and hypointensity, compared with the background agar. The volume of thrombus was calculated and correlated with its signal intensity.
For white thrombi, 11/12 clots showed hyperintensity and 1/12 showed isointensity in FLAIR T1 images. In T2WI, 6/12 clots showed hyperintensity, 3/12 isointensity, and 3/12 hypointensity. In FLAIR T2, 8/12 clots showed hyperintensity and 4/12 showed isointensity. In T2 GRE, 3/12 clots showed hyperintensity and the remaining 9/12 clots showed isointensity. In SWAN, 5/12 clots demonstrated hyperintensity and 7/12 isointensity. For the red thrombus, 12/12 clots demonstrated hyperintensity in FLAIR T1, T2WI, and FLAIR T2 sequences. In T2 GRE and SWAN sequences, 3/12 clots displayed hypointensity and the remaining 9/12 clots showed slight hyperintensity. Thrombi with hypointensity displayed in T2 GRE and SWAN sequences were significantly larger than those with hyperintensity.
Differentiation of white and red thrombi with conventional MR sequence is unreliable, because both kinds of thrombi do not possess unique signal intensity features in these sequences. Red thrombus may or may not show hypointensity in the susceptibility sensitive MR sequences, depending on its size and time course.
早期识别动脉血栓的组成可能具有诊断、治疗和预后意义。白色血栓和红色血栓之间磁共振（MR）信号强度的变化，尤其是在敏感性 MR 序列中，尚不清楚。我们的研究旨在通过一项体模研究评估 MRI 区分白色血栓和红色血栓的可行性。
用静脉血制备了 12 个红色血栓和 12 个白色血栓。使用 3.0T MR 仪完成体模检查，包括液体衰减反转恢复（FLAIR）T1、T2 加权成像（T2WI）、FLAIR T2、T2 梯度回波（T2 GRE）成像和磁化率加权血管造影序列（SWAN）。将血栓的 MR 信号强度模式与背景琼脂进行比较，客观地分为高信号、等信号和低信号。计算血栓的体积并与其信号强度相关联。
对于白色血栓，12 个血栓中有 11 个在 FLAIR T1 图像中呈高信号，1 个呈等信号。在 T2WI 中，6 个血栓呈高信号，3 个呈等信号，3 个呈低信号。在 FLAIR T2 中，8 个血栓呈高信号，4 个呈等信号。在 T2 GRE 中，3 个血栓呈高信号，其余 9 个呈等信号。在 SWAN 中，5 个血栓呈高信号，7 个呈等信号。对于红色血栓，12 个血栓在 FLAIR T1、T2WI 和 FLAIR T2 序列中均呈高信号。在 T2 GRE 和 SWAN 序列中，3 个血栓呈低信号，其余 9 个呈轻度高信号。在 T2 GRE 和 SWAN 序列中呈低信号的血栓明显大于呈高信号的血栓。
常规 MR 序列区分白色血栓和红色血栓不可靠，因为这两种血栓在这些序列中没有独特的信号强度特征。红色血栓在敏感 MR 序列中可能呈低信号，也可能不呈低信号，这取决于其大小和时间过程。
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