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

Abstract

Introduction Timely diagnosis and treatment of portal vein thrombosis (PVT) is crucial to prevent morbidity and mortality. However, current imaging tests cannot always accurately differentiate acute from chronic (nonocclusive) PVT. Magnetic resonance noncontrast thrombus imaging (MR-NCTI) has been shown to accurately differentiate acute from chronic venous thrombosis at other locations and may also be of value in the diagnostic management of PVT. This study describes the first phase of the Rhea study (NTR 7061). Our aim was to select and optimize MR-NCTI sequences that would be accurate for differentiation of acute from chronic PVT. Study Design The literature was searched for different MRI sequences for portal vein and acute thrombosis imaging. The most promising sequences were tested in a healthy volunteer followed by one patient with acute PVT and two patients with chronic PVT, all diagnosed on (repetitive) contrast-enhanced computed tomography (CT) venography to optimize the MR-NCTI sequences. All images were evaluated by an expert panel. Results Several MR-NCTI sequences were identified and tested. Differentiation of acute from chronic PVT was achieved with 3D T1 TFE (three-dimensional T1 turbo field echo) and 3D T1 Dixon FFE (three-dimensional T1 fast field echo) sequences with best image quality. The expert panel was able to confirm the diagnosis of acute PVT on the combined two MR-NCTI sequences and to exclude acute PVT in the two patients with chronic PVT. Conclusion Using 3D T1 TFE and 3D T1 Dixon FFE sequences, we were able to distinguish acute from chronic PVT. This clinical relevant finding will be elucidated in clinical studies to establish their test performance.

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

“…Moreover, contrast of fresh thrombus itself. 7,[11][12][13][14][22][23][24][25][26] 3D TSE-SPAIR has some advantages over MRDTI sequences, including a higher spatial resolution of the vessel wall and less inflow artefacts in the arteries. 14 The two techniques were found to be potentially feasible for the diagnosis of UEDVT, which was confirmed in this study.…”

“… 21 MR‐NCTI has the advantage of direct thrombus visualization without the use of a contrast agent as the technique is based on the intrinsic contrast of fresh thrombus itself. 7 , 11 , 12 , 13 , 14 , 22 , 23 , 24 , 25 , 26 3D TSE‐SPAIR has some advantages over MRDTI sequences, including a higher spatial resolution of the vessel wall and less inflow artefacts in the arteries. 14 The two techniques were found to be potentially feasible for the diagnosis of UEDVT, which was confirmed in this study.…”

“… 9 , 10 , 11 Moreover, MR‐NCTI has shown to be useful in other locations where the diagnosis of thrombosis can be difficult, including isolated pelvic vein thrombosis in pregnant patients and portal vein thrombosis. 12 , 13 Three‐dimensional turbo spin‐echo spectral attenuated inversion recovery (3D TSE‐SPAIR) is another T1‐weighted MR‐NCTI sequence that could be useful in the diagnostic management of UEDVT. Both MRDTI and 3D TSE‐SPAIR were found feasible for the diagnosis of UEDVT in a recent small pilot study.…”

Splanchnic Vein Thrombosis: The State-of-the-Art on Anticoagulant Treatment

“…50 Recent data suggest that MR non-contrast thrombus imaging (MR-NCTI), a non-contrast-enhanced modality also known as MR direct thrombus imaging, might help differentiate an acute PVT from a chronic PVT. 72 MR-NCTI detects fresh thrombi as high signal intensity due to methemoglobin formation, while the signal intensity is reduced in chronic thrombi due to the lower content of methemoglobin.…”

Use of Magnetic Resonance Direct Thrombus Imaging for the Diagnostic Management of Suspected Thrombosis in Routine Clinical Practice

“…Therefore, MRDTI could play a role in specific clinical situations such as the differentiation between residual or chronic thrombi and acute thrombosis, suspected thrombosis in the deep veins within the pelvis—whether or not during pregnancy—and the diagnosis of upper extremity DVT. 6 7 8 9 10 The safety of MRDTI as a diagnostic test for excluding acute recurrent ipsilateral DVT of the leg was evaluated in the prospective management Theia study (NCT02262052). 6 MRDTI proved to be a feasible and reproducible diagnostic test and was suggested to be considered in patients with suspected recurrent ipsilateral DVT and a CUS inconclusive for the diagnosis of recurrence.…”