Diagnosing upper extremity deep vein thrombosis with non-contrast-enhanced Magnetic Resonance Direct Thrombus Imaging: A pilot study

Abstract

Diagnosing upper extremity deep vein thrombosis (UEDVT) can be challenging. Compression ultrasonography is often inconclusive because of overlying anatomic structures that hamper compressing veins. Contrast venography is invasive and has a risk of contrast allergy. Magnetic Resonance Direct Thrombus Imaging (MRDTI) and Three Dimensional Turbo Spin-echo Spectral Attenuated Inversion Recovery (3D TSE-SPAIR) are both non-contrast-enhanced Magnetic Resonance Imaging (MRI) sequences that can visualize a thrombus directly by the visualization of methemoglobin, which is formed in a fresh blood clot. MRDTI has been proven to be accurate in diagnosing deep venous thrombosis (DVT) of the leg. The primary aim of this pilot study was to test the feasibility of diagnosing UEDVT with these MRI techniques. MRDTI and 3D TSE-SPAIR were performed in 3 pilot patients who were already diagnosed with UEDVT by ultrasonography or contrast venography. In all patients, UEDVT diagnosis could be confirmed by MRDTI and 3D TSE-SPAIR in all vein segments. In conclusion, this study showed that non-contrast MRDTI and 3D TSE-SPAIR sequences may be feasible tests to diagnose UEDVT. However diagnostic accuracy and management studies have to be performed before these techniques can be routinely used in clinical practice.

SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance

“…The main indications for imaging the central veins are assessment of suspected anatomical variants and follow-up of patients with CHD [ 169 ], mapping of pulmonary venous anatomy [ 170 ], vena cava superior syndrome [ 171 ] as well as assessment of the central veins prior to creation of upper extremity vascular access in patients with renal dysfunction [ 172 ]. CMR venography is also increasingly used to assess the peripheral venous system in patients with venous compression syndromes [ 173 ], venous anomalies [ 174 ], and suspected or known deep venous thrombosis of both the upper [ 175 ] and lower extremities [ 176 ].…”

Diagnostic and Therapeutic Management of Upper Extremity Deep Vein Thrombosis

“…A recent pilot study using non-contrast-enhanced magnetic resonance direct thrombus imaging showed promising results in three patients in whom UEDVT was already diagnosed with ultrasonography or venography. This technique, which can visualize the thrombus without the need for venous contrast, recently showed good performance in patients with suspected recurrent lower-extremity DVT [ 32 , 33 ]. A study with MRI direct thrombus imaging was recently completed in 63 subjects with suspected UEDVT, and results are eagerly awaited [ 34 ].…”

Magnetic Resonance Thrombus Imaging to Differentiate Acute from Chronic Portal Vein Thrombosis

“…Furthermore, in a pilot study, 3D T1 TFE and 3D TSE SPAIR sequences successfully confirmed the diagnosis of arm vein thrombosis when compared with ultrasonography or contrast venography. 11 The advantages of 3D TSE-SPAIR over 3D T1 TFE were a higher spatial resolution of the vessel wall and less high signal artifacts in arteries caused by inflow effects. Therefore, both 3D T1 TFE and 3D TSE SPAIR may be suitable for portal vein imaging.…”

“…MR-NCTI has been shown to be a valuable diagnostic test for the diagnosis of upper extremity DVT, pelvic vein, and cerebral vein thrombosis, 11 14 19 and was shown to be an accurate, simple, feasible, and reproducible diagnostic test in suspected recurrent ipsilateral DVT of the leg. 9 There are some important differences between venous thrombosis of the portal vein and that at other locations.…”

“…In conclusion, we were able to identify two MR-NTCI sequences, 3D T1 TFE and 3D T1 Dixon FFE, that were able to diagnose and differentiate acute from chronic PVT. With our previous experience based on imaging of DVT in the lower and upper extremities, 9 11 19 we believe that the image quality is sufficient to be of clinical value and initiate the clinical part of the Rhea study (NTR 7061) to establish the diagnostic accuracy of MR-NCTI for the differentiation of acute from chronic PVT. Furthermore, the interobserver agreement of these sequences for PVT imaging will be assessed.…”