Use of Magnetic Resonance Direct Thrombus Imaging for the Diagnostic Management of Suspected Thrombosis in Routine Clinical Practice

Abstract

Background The noninvasive magnetic resonance direct thrombus imaging (MRDTI) technique can be used to diagnose acute deep vein thrombosis (DVT), without the use of intravenous contrast. MRDTI holds the potential to differentiate between acute and chronic DVT and could be helpful when diagnosing thrombosis is challenging.

Objectives Our objective was to evaluate the application of MRDTI in clinical practice, including the frequency and indications of MRDTI scans performed in practice-based conditions, results, impact on treatment decisions, and associated patient outcomes.

Methods A retrospective study was performed at the Leiden University Medical Center, the Netherlands. MRDTI scans performed since its implementation in patients aged ≥18 years as part of clinical practice for the diagnostic management of suspected thrombosis were evaluated.

Results Between October 2015 and September 2023, 36 patients had undergone MRDTI for the diagnostic evaluation of thrombosis. MRDTI application increased since 2019 (five–eight scans per year). The most common indication was to differentiate between acute and chronic thrombosis, mainly for suspected recurrent ipsilateral DVT after inconclusive compression ultrasonography. In over a third of patients, acute thrombosis was confirmed by MRDTI. MRDTI results determined treatment decisions in all except two patients. One patient had symptomatic thrombosis of the lower extremity within 3 months after an MRDTI of the upper extremity without signs of acute thrombosis (1/23; 4.3%, 95% confidence interval: 0.77–21).

Conclusion Over the past 4 years, MRDTI has been used increasingly in our hospital. MRDTI results guided treatment decisions, which confirms the clinical impact and feasibility of its application in daily practice.

Keywords

venous thrombosis - deep vein thrombosis - magnetic resonance imaging - diagnostic imaging - radiology

Publikationsverlauf

Eingereicht: 16. März 2024

Angenommen: 06. Juni 2024

Accepted Manuscript online:
10. Juni 2024

Artikel online veröffentlicht:
09. Juli 2024

• References

• 1 Moody AR. Direct imaging of deep-vein thrombosis with magnetic resonance imaging. Lancet 1997; 350 (9084) 1073
• 2 Moody AR, Pollock JG, O'Connor AR, Bagnall M. Lower-limb deep venous thrombosis: direct MR imaging of the thrombus. Radiology 1998; 209 (02) 349-355
• 3 Gautam G, Sebastian T, Klok FA. How to differentiate recurrent deep vein thrombosis from postthrombotic syndrome. Hamostaseologie 2020; 40 (03) 280-291
• 4 Moody AR. Magnetic resonance direct thrombus imaging. J Thromb Haemost 2003; 1 (07) 1403-1409
• 5 Westerbeek RE, Van Rooden CJ, Tan M. et al. Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg. J Thromb Haemost 2008; 6 (07) 1087-1092
• 6 van Dam LF, Dronkers CEA, Gautam G. et al; Theia Study Group. Magnetic resonance imaging for diagnosis of recurrent ipsilateral deep vein thrombosis. Blood 2020; 135 (16) 1377-1385
• 7 van Dam LF, Klok FA, Tushuizen ME. et al. Magnetic resonance thrombus imaging to differentiate acute from chronic portal vein thrombosis. TH Open 2020; 4 (03) e224-e230
• 8 Dronkers CE, Srámek A, Huisman MV, Klok FA. Accurate diagnosis of iliac vein thrombosis in pregnancy with magnetic resonance direct thrombus imaging (MRDTI). BMJ Case Rep 2016; 2016: bcr2016218091
• 9 van Dam LF, Dronkers CEA, Gautam G. et al. Detection of upper extremity deep vein thrombosis by magnetic resonance non-contrast thrombus imaging. J Thromb Haemost 2021; 19 (08) 1973-1980
• 10 de Jong CMM, Kroft LJM, van Mens TE, Huisman MV, Stöger JL, Klok FA. Modern imaging of acute pulmonary embolism. Thromb Res 2024; 238: 105-116
• 11 Fraser DG, Moody AR, Morgan PS, Martel AL, Davidson I. Diagnosis of lower-limb deep venous thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Intern Med 2002; 136 (02) 89-98
• 12 Tan M, Mol GC, van Rooden CJ. et al. Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis. Blood 2014; 124 (04) 623-627
• 13 van Dam LF, Kroft LJ, Dronkers CE. et al. Magnetic resonance direct thrombus imaging (MRDTI) can distinguish between old and new thrombosis in the abdominal aorta: a case report. Eur J Case Rep Intern Med 2020; 7 (01) 001351
• 14 Moody AR, Murphy RE, Morgan PS. et al. Characterization of complicated carotid plaque with magnetic resonance direct thrombus imaging in patients with cerebral ischemia. Circulation 2003; 107 (24) 3047-3052
• 15 Murphy RE, Moody AR, Morgan PS. et al. Prevalence of complicated carotid atheroma as detected by magnetic resonance direct thrombus imaging in patients with suspected carotid artery stenosis and previous acute cerebral ischemia. Circulation 2003; 107 (24) 3053-3058
• 16 Bitar R, Moody AR, Leung G. et al. In vivo identification of complicated upper thoracic aorta and arch vessel plaque by MR direct thrombus imaging in patients investigated for cerebrovascular disease. AJR Am J Roentgenol 2006; 187 (01) 228-234
• 17 Jansen CH, Perera D, Makowski MR. et al. Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 2011; 124 (04) 416-424
• 18 Bates SM, Jaeschke R, Stevens SM. et al. Diagnosis of DVT: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (02) e351S-e418S
• 19 Lim W, Le Gal G, Bates SM. et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv 2018; 2 (22) 3226-3256
• 20 van Dam LF, van den Hout WB, Gautam G. et al. Cost-effectiveness of magnetic resonance imaging for diagnosing recurrent ipsilateral deep vein thrombosis. Blood Adv 2021; 5 (05) 1369-1378