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Open Access 01-06-2017 | Magnetic Resonance

Combined MR direct thrombus imaging and non-contrast magnetic resonance venography reveal the evolution of deep vein thrombosis: a feasibility study

Authors: I. A. Mendichovszky, A. N. Priest, D. J. Bowden, S. Hunter, I. Joubert, S. Hilborne, M. J. Graves, T. Baglin, D. J. Lomas

Published in: European Radiology | Issue 6/2017

Abstract

Objectives

Lower limb deep venous thrombosis (DVT) is a common condition with high morbidity and mortality. The aim of the study was to investigate the temporal evolution of the acute thrombus by magnetic resonance imaging (MRI) and its relationship to venous recanalization in patients with recurrent DVTs.

Methods

Thirteen patients with newly diagnosed lower limb DVTs underwent MRI with non-contrast MR venography (NC-MRV) and MR direct thrombus imaging (MR-DTI), an inversion-recovery water-selective fast gradient-echo acquisition. Imaging was performed within 7 days of the acute thrombotic event, then at 3 and 6 months.

Results

By 3 months from the thrombotic event a third of the thrombi had resolved and by 6 months about half of the cases had resolved on the basis of vein recanalisation using NC-MRV. On the initial MR-DTI acute thrombus was clearly depicted by hyperintense signal, while the remaining thrombi were predominantly low signal at 3 and 6 months. Some residual thrombi contained small and fragmented persisting hyperintense areas at 3 months, clearing almost completely by 6 months.

Conclusions

Our study suggests that synergistic venous assessment with combined NC-MRV and MR-DTI is able to distinguish acute venous thrombosis from the established (old) or evolving DVT detected by ultrasound.

Key Points

• MRI can distinguish between acute and evolving or chronic lower limb DVT

• Two advanced MRI techniques can follow the evolution of lower limb DVT

• MRI could be used to avoid an incorrect diagnosis of recurrent DVT

• MRI could help avoid the risks and complications of lifelong anticoagulation therapy

Michiels JJ, Michiels JM, Moossdorff W, Lao M, Maasland H, Palareti G (2015) Diagnosis of deep vein thrombosis, and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014. World J Crit Care Med 4:29–39CrossRefPubMedPubMedCentral

Goldhaber SZ, Bounameaux H (2012) Pulmonary embolism and deep vein thrombosis. Lancet 379:1835–1846CrossRefPubMed

Baglin T, Douketis J, Tosetto A et al (2010) Does the clinical presentation and extent of venous thrombosis predict likelihood and type of recurrence? A patient-level meta-analysis. J Thromb Haemost 8:2436–2442CrossRefPubMed

Bates SM, Jaeschke R, Stevens SM et al (2012) Diagnosis of DVT: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 141:e351S–e418SCrossRefPubMedPubMedCentral

Freyburger G, Trillaud H, Labrouche S et al (1998) D-dimer strategy in thrombosis exclusion–a gold standard study in 100 patients suspected of deep venous thrombosis or pulmonary embolism: 8 DD methods compared. Thromb Haemost 79:32–37PubMed

Perrier A, Desmarais S, Miron MJ et al (1999) Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet 353:190–195CrossRefPubMed

Tan M, van Rooden CJ, Westerbeek RE, Huisman MV (2009) Diagnostic management of clinically suspected acute deep vein thrombosis. Br J Haematol 146:347–360CrossRefPubMed

van der Graaf F, van den Borne H, van der Kolk M, de Wild PJ, Janssen GW, van Uum SH (2000) Exclusion of deep venous thrombosis with D-dimer testing–comparison of 13 D-dimer methods in 99 outpatients suspected of deep venous thrombosis using venography as reference standard. Thromb Haemost 83:191–198PubMed

Michiels JJ, Gadisseur A, Van Der Planken M et al (2005) A critical appraisal of non-invasive diagnosis and exclusion of deep vein thrombosis and pulmonary embolism in outpatients with suspected deep vein thrombosis or pulmonary embolism: how many tests do we need? Int Angiol 24:27–39PubMed

10.

Kearon C, Akl EA, Comerota AJ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 141:e419S–e494SCrossRefPubMedPubMedCentral

11.

Piovella F, Crippa L, Barone M et al (2002) Normalization rates of compression ultrasonography in patients with a first episode of deep vein thrombosis of the lower limbs: association with recurrence and new thrombosis. Haematologica 87:515–522PubMed

12.

Mani V, Alie N, Ramachandran S et al (2015) A multicenter MRI protocol for the evaluation and quantification of deep vein thrombosis. J Vis Exp 2015:e52761

13.

Linkins LA, Stretton R, Probyn L, Kearon C (2006) Interobserver agreement on ultrasound measurements of residual vein diameter, thrombus echogenicity and Doppler venous flow in patients with previous venous thrombosis. Thromb Res 117:241–247CrossRefPubMed

14.

Fraser DG, Moody AR, Morgan PS, Martel AL, Davidson I (2002) Diagnosis of lower-limb deep venous thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Intern Med 136:89–98CrossRefPubMed

15.

Saha P, Andia ME, Modarai B et al (2013) Magnetic resonance T1 relaxation time of venous thrombus is determined by iron processing and predicts susceptibility to lysis. Circulation 128:729–736CrossRefPubMedPubMedCentral

16.

Moody AR (2003) Magnetic resonance direct thrombus imaging. J Thromb Haemost 1:1403–1409CrossRefPubMed

17.

Moody AR, Pollock JG, O'Connor AR, Bagnall M (1998) Lower-limb deep venous thrombosis: direct MR imaging of the thrombus. Radiology 209:349–355CrossRefPubMed

18.

Tan M, Mol GC, van Rooden CJ et al (2014) Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis. Blood 124:623–627CrossRefPubMed

19.

Westerbeek RE, Van Rooden CJ, Tan M et al (2008) Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg. J Thromb Haemost 6:1087–1092CrossRefPubMed

20.

Mani V, Alie N, Ramachandran S et al (2015) A multicenter MRI protocol for the evaluation and quantification of deep vein thrombosis. J Vis Exp. doi:10.3791/52761 PubMed

21.

Ono A, Murase K, Taniguchi T et al (2010) Deep venous thrombosis: diagnostic value of non-contrast-enhanced MR venography using electrocardiography-triggered three-dimensional half-Fourier FSE. Magn Reson Med 64:88–97CrossRefPubMed

22.

Priest AN, Graves MJ, Lomas DJ (2012) Non-contrast-enhanced vein imaging in the deep veins: impact of velocity patterns and improved image quality. Proc Intl Soc Magn Reson Med 20:1210

23.

Priest AN, Joubert I, Hilborne S, Hunter S, Bowden DJ, Graves MJ, Baglin T, Lomas DJ (2013) Non-contrast-enhanced imaging of lower limb veins: improved imaging using multiple flow preparations. Proc Intl Soc Magn Reson Med 21:1287

24.

Priest AN, Graves MJ, Lomas DJ (2012) Non-contrast-enhanced vascular magnetic resonance imaging using flow-dependent preparation with subtraction. Magn Reson Med 67:628–637CrossRefPubMed

25.

Priest AN, Taviani V, Graves MJ, Lomas DJ (2014) Improved artery-vein separation with acceleration-dependent preparation for non-contrast-enhanced magnetic resonance angiography. Magn Reson Med 72:699–706CrossRefPubMed

26.

Priest AN, Joubert I, Hilborne S, Hunter S, Bowden DJ, Graves MJ, Baglin T, Gillard JH, Lomas DJ (2013) MR direct thrombus imaging with optimised signal and improved lipid suppression. Proc Intl Soc Magn Reson Med 21:1280

Title: Combined MR direct thrombus imaging and non-contrast magnetic resonance venography reveal the evolution of deep vein thrombosis: a feasibility study
Authors: I. A. Mendichovszky
A. N. Priest
D. J. Bowden
S. Hunter
I. Joubert
S. Hilborne
M. J. Graves
T. Baglin
D. J. Lomas
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 6/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4555-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Combined MR direct thrombus imaging and non-contrast magnetic resonance venography reveal the evolution of deep vein thrombosis: a feasibility study

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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