Contrast-Enhanced Anatomic Imaging as Compared to Contrast-Enhanced Tissue Characterization for Detection of Left Ventricular Thrombus
Jonathan W. Weinsaft, MD*, ,*,
Raymond J. Kim, MD ,
Michael Ross, MD*,
Daniel Krauser, MD*,
Shant Manoushagian, BA*,
Troy M. LaBounty, MD*,
Matthew D. Cham, MD*,,
James K. Min, MD*,,
Kirsten Healy, MD*,
Yi Wang, PhD,
Michele Parker, MS, RN,
Mary J. Roman, MD*,
Richard B. Devereux, MD*
* Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York
Department of Radiology, Weill Cornell Medical College, New York, New York
Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina
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Figure 1 Apical Thrombus by Anatomic and Tissue Characterization Imaging
(A) Representative example of apical thrombus (circle) concordantly detected by anatomic imaging (left, contrast echocardiography 4-chamber, cine-CMR 2-chamber) and DE-CMR (center). (B) Representative example of discordance between anatomic imaging and DE-CMR. DE-CMR identified a small mural thrombus (circle) within the apex. Cine-CMR and contrast echocardiography were interpreted as negative. For both examples, surgical resection enabled thrombus verification based on histopathology (right, hematoxylin and eosin stain, low power), which showed thrombus with associated fibroblasts (*). CMR = cardiac magnetic resonance; DE = delayed-enhancement.
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Figure 2 Nonapical Thrombus Despite Negative Anatomic Imaging
Representative example of nonapical thrombus detection by DE-CMR despite negative anatomic imaging. Noncontrast and contrast echocardiography (left, 2-chamber view) were negative for thrombus. Cine-CMR (middle) identified thrombus, attributable to acquisition of both short- and long-axis images. DE-CMR (right, 2-chamber view) identified a large mural thrombus (circle) adjacent to the basal inferior wall. Abbreviations as in Figure 1.
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Figure 3 Thrombus Size in Relation to Echo Detection
Apical thrombi detected by contrast echocardiography were larger than those missed, with a similar trend for noncontrast echocardiography (data shown as mean ± SD).
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