Contrast-enhanced CMR is equally effective as TEE in the evaluation of left atrial appendage thrombus in patients with atrial fibrillation undergoing pulmonary vein isolation procedure

MR Imaging in Hypertrophic Cardiomyopathy: From Magnet to Bedside

“…In patients referred for catheter ablation of atrial fibrillation, a multiparametric MR imaging approach combining cine imaging with contrastenhanced MR angiography and imaging early following contrast agent administration represents a valuable alternative to transesophageal echocardiography for evaluation of pulmonary vein anatomy and exclusion of thrombus in the left atrial appendage (Table 3) (114). Furthermore, LGE imaging enables the assessment of additional arrhythmic substrates and postablation lesions within the left atrium (115). Recently, ablation procedures in an MR environment have become feasible in the research setting, potentially opening the door for radiation-free procedures in HCM patients (116,117).…”

Cardiac CT and MRI for Assessment of Cardioembolic Stroke

“…Because a two-phase protocol increases patient radiation exposure, the supplementary role of CT can be most valuable in cases where performing TTE or TEE is hampered by limited experience or contraindication due to medical reasons [11]. Cardiac MRI can be proposed as an effective, safer, and comprehensive imaging modality comparable to TEE for the evaluation of LAA thrombi, although its slower image acquisition and inability to be used in patients with implanted metallic devices interfere with the feasibility of cardiac MRI [12].…”

Technological Improvements in Cardiac Thrombus Diagnosis

“…CMR imaging can be used to evaluate potential sources of emboli, such as LAA thrombi or LV thrombi [62][63][64]. Several studies have reported that CMR has high reproducibility and high sensitivity for detecting LAA thrombus, compared to TEE [62,63].…”

“…Several studies have reported that CMR has high reproducibility and high sensitivity for detecting LAA thrombus, compared to TEE [62,63]. Diagnostically, CMR imaging is potentially more advantageous, compared with echocardiography because of its …”

“…However, one of the drawbacks of CMR is that it is far from an ideal modality as it has limited spatial resolution and susceptibility to slow flow, which can create artifact-mimicking, space-occupying lesions. Spatial resolution and image contrast between the background and LA and LAA wall, as well as slow flow within the LA and LAA, can affect the 3-dimensional contrast-enhanced CMR thrombus evaluation [63]. Imaging artifacts are also commonly encountered in cine-CMR; these include breathing motion, flow-related, and inhomogeneity artifacts.…”