Abstract
Introduction Magnetic resonance direct thrombus imaging (MRDTI) is a promising technique to improve
the diagnostic management of patients with a suspected ipsilateral recurrent deep
vein thrombosis (DVT) by direct visualization of a thrombus. Another magnetic resonance
imaging (MRI) technique, T1-weighted turbo spin-echo spectral attenuated inversion
recovery (TSE-SPAIR), has the potential to image a thrombus directly with a high spatial
resolution as well. The main aim of this pilot study was to investigate if adding
the TSE-SPAIR sequence to an MRDTI sequence performed in patients with suspected recurrent
DVT may increase the diagnostic confidence of expert MRDTI readers.
Methods Fifteen patients with suspected acute recurrent DVT were included in this study.
The TSE-SPAIR sequence was scanned directly after the MRDTI scan but not used to guide
clinical decision making, and both scans were adjudicated post hoc two times separately
by three independent expert MRDTI readers. Diagnostic confidence was scored on a 4-point
Likert scale: (1) poor (definite diagnosis impossible), (2) fair (evaluation of major
findings possible), (3) good (definite diagnosis possible), and (4) excellent (exact
diagnosis possible).
Results The diagnostic confidence of expert readers increased when adding the TSE-SPAIR sequence
on top of the MRDTI sequence from “good” (median, 3.0; interquartile range [IQR],
2.66–3.0) to “excellent” (median, 3.67; IQR 3.33–3.67; p = 0.001). Evaluation of the scans in the reversed order 5 months after initial reading
showed similar results. Diagnostic accuracy for proximal DVT of both scan techniques
was good.
Conclusion The extra TSE-SPAIR sequence may help increase diagnostic confidence of radiologists
in cases of uncertain diagnosis in patients with suspected ipsilateral recurrent DVT.
Keywords
magnetic resonance imaging - venous thrombosis - diagnosis
