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(Circulation. 2002;106:2873.)
© 2002 American Heart Association, Inc.

Brief Rapid Communications

Visualization of Ventricular Thrombi With Contrast-Enhanced Magnetic Resonance Imaging in Patients With Ischemic Heart Disease

Nico R. Mollet, MD; Steven Dymarkowski, MD; Wim Volders, MD; Jurgen Wathiong, MD; Lieven Herbots, MD; Frank E. Rademakers, MD; Jan Bogaert, MD

From the Departments of Radiology (N.R.M., S.D., W.V., J.W., J.B.) and Cardiology (L.H., F.E.R.), Gasthuisberg University Hospital, Leuven, Belgium.

Correspondence to Jan Bogaert MD, PhD, Department of Radiology, Gasthuisberg University Hospital, Herestraat 49, B-3000 Leuven, Belgium. E-mail Jan.Bogaert{at}uz.kuleuven.ac.be

Background— Ventricular thrombus formation is a frequent and potentially dangerous complication in patients with ischemic heart disease. Although transthoracic echocardiography (TTE) is generally used as diagnostic technique, we explored the role of contrast-enhanced (CE)-MRI to detect ventricular thrombi.

Methods and Results— In 57 patients with acute myocardial infarction, chronic myocardial infarction, or ischemic cardiomyopathy, MRI was performed to evaluate ventricular function (CINE-MRI) and to depict presence of myocardial necrosis and/or scarring and no-reflow areas (CE-MRI). All studies were analyzed for concomitant ventricular thrombi. CE-MRI depicted 12 mural thrombi (3.1±2.9 cm³), located in left ventricular (LV) apex or adherent to anteroseptum, presenting as black, well-defined structures surrounded by bright contrast-enhanced blood. Thrombus formation on CE-MRI was related to larger end-diastolic volumes; lower ejection fractions; the region of delayed enhancement and lowest wall motion score, especially in left anterior descending coronary artery territory; and LV aneurysm formation. On CINE-MRI, thrombi were found in 6 patients. Nonvisualized thrombi were usually small (mean size 1.2±0.7 cm³). TTE depicted thrombi in 5. Nonvisualized lesions were most frequently located in LV apex and had a larger size than nonvisualized lesions on CINE-MRI (3.0±3.2 cm³). In 3 patients with suspected apical thrombus on TTE, MRI was normal.

Conclusions— CE-MRI is not only an excellent technique to depict myocardial necrosis and scar tissue in patients with ischemic heart disease, but this study also suggests a better identification of LV thrombi than with presently used clinical imaging modalities, such as TTE.

Key Words: magnetic resonance imaging • thrombus • echocardiography • heart disease • myocardial infarction

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