Department of Minimally Invasive Interventional Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China.
Department of Radiology, Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, China.
Thromb Haemost. 2023 Apr;123(4):453-463. doi: 10.1055/s-0043-1760846. Epub 2023 Feb 8.
Catheter-directed thrombolysis (CDT) is an effective therapy for acute deep vein thrombosis (DVT). However, predicting the CDT outcomes remains elusive. We hypothesized that the thrombus signal on T1-weighted black-blood magnetic resonance (MR) can provide insight into CDT outcomes in acute DVT patients.
A total of 117 patients with acute iliofemoral DVT were enrolled for T1-weighted black-blood MR before CDT in this prospective study. Based on the signal contrast between thrombus and adjacent muscle, patients were categorized into the iso-intense thrombus (Iso-IT), hyper-intense thrombus (Hyper-IT), and mixed iso-/hyper-intense thrombi (Mixed-IT) groups. Immediate treatment outcome (i.e., vein patency) and long-term treatment outcome (i.e., the incidence rate of postthrombotic syndrome) were accessed by the same expert. Histological analysis and iron quantification were performed on thrombus samples to characterize the content of fibrin, collagen, and the ratio of Fe to total iron.
Compared to Mixed-IT and Hyper-IT groups, the Iso-IT group had the best lytic effect (90.5 ± 1.6% vs. 78.4 ± 2.6% vs. 46.5 ± 3.3%, < 0.001), lowest bleeding ratio (0.0 vs. 11.8 vs. 13.3, < 0.001), and the lowest incidence rate of postthrombotic syndrome on 24 months (3.6 vs. 18.4 vs. 63.4%, < 0.001) following CDT. The Iso-IT group had a significantly lower ratio of Fe to total iron (93.1 ± 3.2% vs. 97.2 ± 2.1%, = 0.034) and a higher content of fibrin (12.5 ± 5.3% vs. 4.76 ± 3.18%, = 0.023) than Hyper-IT.
Thrombus signal characteristics on T1-weighted black-blood MR is associated with CDT outcomes and possesses potential to serve as a noninvasive approach to guide treatment decision making in acute DVT patients.
· Thrombus signal on T1-weighted black-blood MR is associated with lytic therapeutic outcome in acute DVT patients.. · Presence of iso-intense thrombus revealed by T1-weighted black-blood MRI is associated with successful thrombolysis, low bleeding ratio, and low incidence of the postthrombotic syndrome.. · T1-weighted thrombus signal characteristics may serve as a noninvasive imaging marker to predict CDT treatment outcomes and therefore guide treatment decision making in acute DVT patients..
导管溶栓（CDT）是治疗急性深静脉血栓形成（DVT）的有效方法。然而，预测 CDT 结局仍然难以捉摸。我们假设 T1 加权黑血磁共振（MR）上的血栓信号可以深入了解急性 DVT 患者的 CDT 结局。
在这项前瞻性研究中，共有 117 例急性髂股 DVT 患者在 CDT 前接受 T1 加权黑血 MR 检查。根据血栓与相邻肌肉之间的信号对比，患者分为等信号血栓（Iso-IT）、高信号血栓（Hyper-IT）和混合等/高信号血栓（Mixed-IT）组。由同一位专家评估即刻治疗结局（即静脉通畅）和长期治疗结局（即血栓后综合征发生率）。对血栓样本进行组织学分析和铁定量，以表征纤维蛋白、胶原和 Fe 与总铁的比值。
与 Mixed-IT 和 Hyper-IT 组相比，Iso-IT 组的溶栓效果最好（90.5±1.6%比 78.4±2.6%比 46.5±3.3%，<0.001），出血比例最低（0.0 比 11.8 比 13.3，<0.001），CDT 后 24 个月血栓后综合征发生率最低（3.6 比 18.4 比 63.4%，<0.001）。Iso-IT 组的 Fe 与总铁的比值（93.1±3.2%比 97.2±2.1%，=0.034）显著较低，纤维蛋白含量（12.5±5.3%比 4.76±3.18%，=0.023）较高。
T1 加权黑血 MR 上的血栓信号特征与 CDT 结局相关，有可能成为指导急性 DVT 患者治疗决策的一种非侵入性方法。
· T1 加权黑血 MR 上的血栓信号与急性 DVT 患者的溶栓治疗结局相关。
· T1 加权黑血 MRI 显示等信号血栓与溶栓成功、低出血比例和低血栓后综合征发生率相关。
· T1 加权血栓信号特征可作为一种无创性成像标志物，预测 CDT 治疗结局，从而指导急性 DVT 患者的治疗决策。
