Black-blood thrombus imaging (BTI): a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis

Guoxi Xie,Hanwei Chen,Xueping He,Zhuonan He,Xin Liu,Wei Deng,Yufeng Ye,Jianke Liang,Xiaoming Bi,Zhaoyang Fan,Debiao Li,Qi Yang

doi:10.1186/s12968-016-0320-8

Abstract

BackgroundDeep vein thrombosis (DVT) is a common but elusive illness that can result in long-term disability or death. Accurate detection of thrombosis and assessment of its size and distribution are critical for treatment decision-making. In the present study, we sought to develop and evaluate a cardiovascular magnetic resonance (CMR) black-blood thrombus imaging (BTI) technique, based on delay alternating with nutation for tailored excitation black-blood preparation and variable flip angle turbo-spin-echo readout, for the diagnosis of non-acute DVT.MethodsThis prospective study was approved by institutional review board and informed consent obtained from all subjects. BTI was first conducted in 11 healthy subjects for parameter optimization and then conducted in 18 non-acute DVT patients to evaluate its diagnostic performance. Two clinically used CMR techniques, contrast-enhanced CMR venography (CE-MRV) and three dimensional magnetization prepared rapid acquisition gradient echo (MPRAGE), were also conducted in all patients for comparison. All images obtained from patients were analyzed on a per-segment basis. Using the consensus diagnosis of CE-MRV as the reference, the sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV), and accuracy (ACC) of BTI and MPRAGE as well as their diagnostic agreement with CE-MRV were calculated. Besides, diagnostic confidence and interreader diagnostic agreement were evaluated for all three techniques.ResultsBTI with optimized parameters effectively nulled the venous blood flow signal and allowed directly visualizing the thrombus within the black-blood lumen. Higher SE (90.4% vs 67.6%), SP (99.0% vs. 97.4%), PPV (95.4% vs. 85.6%), NPV (97.8% vs 92.9%) and ACC (97.4% vs. 91.8%) were obtained by BTI in comparison with MPRAGE. Good diagnostic confidence and excellent diagnostic and interreader agreements were achieved by BTI, which were superior to MPRAGE on detecting the chronic thrombus.ConclusionBTI allows direct visualization of non-acute DVT within the dark venous lumen and has the potential to be a reliable diagnostic tool without the use of contrast medium.

Highlights

Deep vein thrombosis (DVT) is a common but elusive illness that can result in long-term disability or death
Healthy volunteer study According to Contrast-to-noise ratios (CNR) analysis, delay alternating with nutation for tailored excitation (DANTE) with a pulse train length (PTL) of 125– 175 appeared to be a suitable preparation to yield sufficient blood flow suppression without considerable signal loss in static tissues (Fig. 2)
Considering that the venous flow could be even slower in DVT patients, a PTL of 175 was chosen as the optimal parameter for blood thrombus imaging (BTI)

Summary

Introduction

Deep vein thrombosis (DVT) is a common but elusive illness that can result in long-term disability or death. Deep vein thrombosis (DVT) is a common but elusive illness, affecting about 1 in 1000 population every year [1]. Its sequelae include post-thrombotic syndrome and pulmonary embolism, which can result in long-term disability or death [2]. Ultrasonography (US) is a daily used technique because of its noninvasiveness, low cost and wide availability [8]. It has largely replaced the gold standard but invasive and radiation-required approach, x-ray venography, in clinical settings [7, 9]. US is unable to differentiate recurrent thrombosis from residual thrombosis and can only provide limited guidance for DVT treatment [11,12,13,14]

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