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Thrombus Detection in the Left Atrial Appendage Using Contrast-Enhanced MRI: A Pilot Study

¹ Cardiovascular Center Bethanien (CCB), Im Pruefling 23, D-60389 Frankfurt/Main, Germany.
² German Cancer Research Center (DKFZ), Heidelberg, Germany.
³ University of Oxford Centre for Clinical MR Research (OCMR), Oxford, United Kingdom.

View larger version (155K): [in a new window]   Fig. 1A —Example of true-positive results by 2D perfusion imaging and 3D turbo fast low-angle shot (FLASH) imaging (patient 8, Table 1). Movie 1, available online for viewing at www.ajronline.org, shows filling defect of atrial appendage body and apex in dynamic information provided by 2D perfusion imaging. LA = left atrium, LAA = left atrial appendage, LV = left ventricle, PV = pulmonary vein, Av = aortic valve. Transesophageal echocardiography image (A), 2D perfusion image (B), and 3D turboFLASH (C) show thrombus (arrows) in left atrial appendage body extending into apex.

View larger version (148K): [in a new window]   Fig. 1B —Example of true-positive results by 2D perfusion imaging and 3D turbo fast low-angle shot (FLASH) imaging (patient 8, Table 1). Movie 1, available online for viewing at www.ajronline.org, shows filling defect of atrial appendage body and apex in dynamic information provided by 2D perfusion imaging. LA = left atrium, LAA = left atrial appendage, LV = left ventricle, PV = pulmonary vein, Av = aortic valve. Transesophageal echocardiography image (A), 2D perfusion image (B), and 3D turboFLASH (C) show thrombus (arrows) in left atrial appendage body extending into apex.

View larger version (162K): [in a new window]   Fig. 1C —Example of true-positive results by 2D perfusion imaging and 3D turbo fast low-angle shot (FLASH) imaging (patient 8, Table 1). Movie 1, available online for viewing at www.ajronline.org, shows filling defect of atrial appendage body and apex in dynamic information provided by 2D perfusion imaging. LA = left atrium, LAA = left atrial appendage, LV = left ventricle, PV = pulmonary vein, Av = aortic valve. Transesophageal echocardiography image (A), 2D perfusion image (B), and 3D turboFLASH (C) show thrombus (arrows) in left atrial appendage body extending into apex.

View larger version (141K): [in a new window]   Fig. 2A —Example of false-negative results by 2D perfusion imaging and 3D turbo fast low-angle shot (FLASH) imaging (patient 7, Table 1). No filling defect of atrial appendage body is visible in dynamic information provided by 2D perfusion imaging in movie 2, which is available for viewing online at www.ajronline.org. LA = left atrium, LAA = left atrial appendage, LV = left ventricle. Transesophageal echocardiography image shows thrombus (arrow) in body of left atrial appendage body.

View larger version (151K): [in a new window]   Fig. 2B —Example of false-negative results by 2D perfusion imaging and 3D turbo fast low-angle shot (FLASH) imaging (patient 7, Table 1). No filling defect of atrial appendage body is visible in dynamic information provided by 2D perfusion imaging in movie 2, which is available for viewing online at www.ajronline.org. LA = left atrium, LAA = left atrial appendage, LV = left ventricle. On 2D perfusion image (B) and 3D turboFLASH (C), thrombus is not visualized.

View larger version (143K): [in a new window]   Fig. 2C —Example of false-negative results by 2D perfusion imaging and 3D turbo fast low-angle shot (FLASH) imaging (patient 7, Table 1). No filling defect of atrial appendage body is visible in dynamic information provided by 2D perfusion imaging in movie 2, which is available for viewing online at www.ajronline.org. LA = left atrium, LAA = left atrial appendage, LV = left ventricle. On 2D perfusion image (B) and 3D turboFLASH (C), thrombus is not visualized.

View larger version (142K): [in a new window]   Fig. 3A —Example of true-positive result in 2D perfusion imaging and false-negative result in 3D turbo fast low-angle shot (FLASH) imaging (patient 4, Table 1). LA = left atrium, LAA = left atrial appendage, LV = left ventricle. Transesophageal echocardiography image reveals thrombus (arrow) in apex of left atrial appendage.

View larger version (133K): [in a new window]   Fig. 3B —Example of true-positive result in 2D perfusion imaging and false-negative result in 3D turbo fast low-angle shot (FLASH) imaging (patient 4, Table 1). LA = left atrium, LAA = left atrial appendage, LV = left ventricle. Two-dimensional perfusion image depicts thrombus (arrow), which is also shown on movie 3, available for viewing online at www.ajronline.org.

View larger version (157K): [in a new window]   Fig. 3C —Example of true-positive result in 2D perfusion imaging and false-negative result in 3D turbo fast low-angle shot (FLASH) imaging (patient 4, Table 1). LA = left atrium, LAA = left atrial appendage, LV = left ventricle. Thrombus is not visible on 3D turboFLASH.

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