EXPERIMENTAL STUDY
In vivo noninvasive detection and age definition of arterial thrombus by MRI
Roberto Corti, MD* ,
Julio I. Osende, MD*,
Zahi A. Fayad, PhD ,
John T. Fallon, MD, PhD, FACC ,
Valentin Fuster, MD, PhD, FACC,
Gabor Mizsei, MS,
Elisha Dickstein, BA,*,
Burton Drayer, MD and
Juan J. Badimon, PhD, FACC*,*
* Cardiovascular Biology Research Laboratory, Mount Sinai Medical Center, New York, New York, USA
Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA
Department of Radiology, Mount Sinai Medical Center, New York, New York, USA
Department of Pathology, Mount Sinai Medical Center, New York, New York, USA
* Reprint requests and correspondence: Dr. Juan J. Badimon, Cardiovascular Biology Research Laboratory, Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, Box 1030, New York, New York 10029-6574 USA.
juan.badimon{at}mssm.edu
OBJECTIVES: The purpose of this study was to evaluate the potential of magnetic resonance (MR) to detect arterial thrombotic obstruction and define thrombus age.
BACKGROUND: Arterial thrombi underlie the clinical consequences of atherosclerosis and are not reliably detected by current noninvasive diagnostic techniques.
METHODS: Carotid thrombi were induced in swine (n = 7) by arterial injury. Serial high-resolution in vivo MR images were obtained using black-blood T1-weighted (T1W) and T2-weighted (T2W) sequences in a clinical 1.5T MR system at 6 h, 1 day and at 1, 2, 3, 6 and 9 weeks. At each time point one animal was sacrificed and the occluded carotid artery processed for histopathology. Thrombus signal intensity (SI) was normalized to that of the adjacent muscle. Thrombus age was assessed based on MR appearance by two blinded independent observers.
RESULTS: Thrombus appearance and relative SI revealed characteristic temporal changes in multicontrast-weighted MR images, reflecting histologic changes in the composition. Acute thrombus appeared very bright on the T2W images, facilitating the detection. Signal intensity was 197 ± 25% at 6 h, peaking at 1 week (246 ± 51%), reaching a plateau by 6 weeks (120 ± 15%). At six weeks, complete thrombus organization was confirmed histologically. The T1W images had similar pattern with lower SI than T2W. Age definition using visual appearance was highly accurate (Pearson’s chi-square with 4 df ranging from 96 to 132 and Cohen’s kappa at 0.81 to 0.94). Agreement between observers was substantial (Pearson chi-square with 4 df = 91.5, kappa = 0.79).
CONCLUSIONS: Magnetic resonance imaging is a promising tool to noninvasively detect arterial thrombosis. Measurement of SI and the characteristic visual appearance of the thrombus have the potential to define thrombus age.
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Abbreviations and Acronyms
| | df | | degree of freedom | | LL | | Log Likelihood | | MR | | magnetic resonance | | RBC | | red blood cell | | SI | | signal intensity | | TE | | echo time | | TR | | repetition time | | T1W | | T1-weighted | | T2W | | T2-weighted | | 2IR-FSE | | double inversion recovery fast spin echo |
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