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Figure 1 DE-CMR Compared With Cine-CMR for Identification of Pathology-Verified Thrombus

(A) Typical images from a patient with concordant findings by DE-CMR and cine-CMR. Both techniques show an intracavitary thrombus within the LV apex (4-chamber views). Pathology (hematoxylin and eosin stain, low power) confirmed the presence of thrombus with organizing features, including prominent collagen and fibrin content. (B) Typical images from a patient with discordant findings by DE-CMR and cine-CMR. DE-CMR demonstrates a large mural thrombus adherent to a left ventricular inferior wall aneurysm, whereas cine-CMR shows no evidence of thrombus (midventricular short-axis views). Thrombus was verified by pathology (gross examination [overlay] and histopathology [inset, Masson trichrome stain]). Both patient examples show that thrombus may have an etched appearance with a black border and a central gray zone on standard inversion time (TI) DE-CMR, whereas it appears homogeneously black on long-TI imaging. See text for details. Thrombus denoted by yellow arrows. CMR = cardiac magnetic resonance; DE-CMR = delayed-enhancement cardiovascular magnetic resonance; LA = left atrium; LV = left ventricle; LVA = left ventricular aneurysm; Myo = myocardium.