Diagnosing Recurrent DVT of the Leg by Two Different Non–Contrast-Enhanced Magnetic Resonance Direct Thrombus Imaging Techniques: A Pilot Study

Abstract

Introduction Magnetic resonance direct thrombus imaging (MRDTI) is a promising technique to improve the diagnostic management of patients with a suspected ipsilateral recurrent deep vein thrombosis (DVT) by direct visualization of a thrombus. Another magnetic resonance imaging (MRI) technique, T1-weighted turbo spin-echo spectral attenuated inversion recovery (TSE-SPAIR), has the potential to image a thrombus directly with a high spatial resolution as well. The main aim of this pilot study was to investigate if adding the TSE-SPAIR sequence to an MRDTI sequence performed in patients with suspected recurrent DVT may increase the diagnostic confidence of expert MRDTI readers. Methods Fifteen patients with suspected acute recurrent DVT were included in this study. The TSE-SPAIR sequence was scanned directly after the MRDTI scan but not used to guide clinical decision making, and both scans were adjudicated post hoc two times separately by three independent expert MRDTI readers. Diagnostic confidence was scored on a 4-point Likert scale: (1) poor (definite diagnosis impossible), (2) fair (evaluation of major findings possible), (3) good (definite diagnosis possible), and (4) excellent (exact diagnosis possible). Results The diagnostic confidence of expert readers increased when adding the TSE-SPAIR sequence on top of the MRDTI sequence from “good” (median, 3.0; interquartile range [IQR], 2.66–3.0) to “excellent” (median, 3.67; IQR 3.33–3.67; p = 0.001). Evaluation of the scans in the reversed order 5 months after initial reading showed similar results. Diagnostic accuracy for proximal DVT of both scan techniques was good. Conclusion The extra TSE-SPAIR sequence may help increase diagnostic confidence of radiologists in cases of uncertain diagnosis in patients with suspected ipsilateral recurrent DVT.

High Signal Intensity on Diffusion-Weighted Images Reflects Acute Phase of Deep Vein Thrombus

“…High accuracy of ultrasound and CT for diagnosis of DVT in lower extremities has been reported. 5 Additionally, previous studies showed that MR direct thrombus imaging, based on T1WI, can detect recurrent DVT [8][9][10] and accurately detect pelvic vein thrombosis in pregnancy. 28 In our study, IVC/pelvic thrombi, incidental, and recurrent DVT were detected by MRI.…”

“…Magnetic resonance (MR) diffusion-weighted imaging (DWI) is noninvasive, and it relies on detecting the random motion of free water molecules. Although several reports have indicated that MR imaging (MRI) is useful for diagnosing DVT, [6][7][8][9][10] a method of defining thrombus age has not been established. The present study aimed to determine whether DWI can detect venous thrombi in patients with DVT, and define thrombus age in a rabbit model compared with histological findings.…”

Detection of upper extremity deep vein thrombosis by magnetic resonance non‐contrast thrombus imaging

“…In all patients with confirmed (group 1) or excluded UEDVT (group 2) MR‐NCTI, including both MRDTI and 3D‐TSE SPAIR sequences, was performed within 48 h of the initial diagnosis. MRI scans were performed with a 1.5 or 3.0 Tesla unit using an integrated 16‐channel posterior coil and a 16‐channel anterior body coil for signal reception 9,10,17 1.…”

Recent advances in understanding, diagnosing and treating venous thrombosis

“…Preliminary studies suggest that 18F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) and magnetic resonance direct thrombus imaging (MRDTI) may be useful for the diagnosis of recurrent DVT. FDG-PET/CT has the potential to differentiate new thrombus from old thrombus because of the preferential uptake of fluorodeoxyglucose by the inflammatory cells that accumulate in newly formed clots 67 , 68 , whereas MRDTI detects the paramagnetic signal induced by release of methemoglobin from fresh thrombus 69 , 70 . In a small prospective study that included 39 patients with recurrent DVT confirmed by the presence of a new non-compressible venous segment on ultrasonography and 42 asymptomatic patients with residual vein occlusion after an index DVT at least 6 months earlier, MDRTI had 95% sensitivity and 100% specificity for detecting recurrent DVT 70 .…”