Rofo 2005; 177(3): 344-349
DOI: 10.1055/s-2004-813898
Herz

© Georg Thieme Verlag KG Stuttgart · New York

Detektion und Charakterisierung linksventrikulärer Thromben mittels MRT im Vergleich zur transthorakalen Echokardiographie

Detection and Characterization of Left Ventricular Thrombi by MRI Compared to Transthoracic EchocardiographyO. Bruder1 , K. U. Waltering2 , P. Hunold2 , M. Jochims1 , B. Narin2 , G. V. Sabin1 , J. Barkhausen2
  • 1Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus Essen
  • 2Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Essen
Further Information

Publication History

Publication Date:
24 January 2005 (online)

Zusammenfassung

Fragestellung: Evaluiert werden sollte die Bedeutung der kardialen MRT in der Diagnostik linksventrikulärer Thromben bei chronischem Myokardinfarkt im Vergleich zur transthorakalen Echokardiographie. Material und Methode: 82 Patienten (55 Männer und 27 Frauen, Alter 36 bis 79, Mittelwert 59 ± 11 Jahre) mit chronischem, mehr als 6 Monate alten Myokardinfarkt wurden mittels transthorakaler Echokardiographie und kontrastverstärkter kardialer MRT untersucht. Ergebnisse: Die transthorakale Echokardiographie konnte 12, die kontrastverstärkte kardiale MRT 35 linksventrikuläre Thromben im Bereich der Infarktnarbe identifizieren. Abgesehen von 2 kleinen apikalen Thromben handelte es sich bei den ausschließlich im MRT detektierten Thromben um parietale Thromben. Linksventrikuläre Thromben fanden sich insgesamt gehäuft bei Patienten mit mittel- bis höhergradig eingeschränkter systolischer linksventrikulärer Gesamtfunktion (32/42 [76 %]) und bei Aneurysmabildung des linken Ventrikels (21/24 [84 %]). Schlussfolgerung: Die kardiale MRT ist der Echokardiographie vor allem in der Darstellung parietaler Thromben nach abgelaufenem Myokardinfarkt überlegen. Intrakavitäre Thromben werden gehäuft bei Patienten mit höhergradig reduzierter LV-Funktion oder schweren regionalen Kontraktionsstörungen in Form einer postinfarziellen linksventrikulären Aneurysmabildung gefunden.

Abstract

Purpose: Transthoracic echocardiography is the routine diagnostic procedure in assessing patients with left ventricular thrombi, but is limited by the acoustic window and poor contrast between thrombus and adjacent myocardium. This study evaluates the role of cardiac MRI in the detection of left ventricular thrombi in patients with chronic myocardial infarction compared to standard transthoracic echocardiography. Materials and Methods: In 82 patients (55 men and 27 women, age 36 to 79 years, median 59 ± 11 years) who suffered a myocardial infarction more than 6 months earlier, transthoracic echocardiography and MRI were performed. The MRI protocol included steady state cine imaging (true FISP: TR 3.0 ms, TE 1.5 ms, FA 65°) in standard long and short axis orientation and contrast-enhanced imaging using a 3D IR-FLASH sequence with long inversion time (TR 4 ms, TE 1.43 ms, FA 10°, TI 300 ms) early, and a 2D IR-FLASH sequence with optimized inversion time (TR 8 ms, TE 4.3 ms, FA 20°, TI 180 - 280 ms) late after administration of gadolinium. Results: Transthoracic echocardiography depicted 12 thrombi. Contrast-enhanced MRI confirmed these 12 thrombi and detected 23 additional thrombi. With the exception of 2 very small apical thrombi only visible on contrast-enhanced MR images, spherical thrombi were diagnosed by both techniques, whereas only contrast-enhanced MRI was able to visualize mural thrombi. Left ventricular thrombi were more frequently diagnosed in patients with moderate to severe impairment of the left ventricular systolic function, 32/42 (76 %), or in patients with left ventricular aneurysms, 21/24 (84 %). Conclusion: Contrast-enhanced MRI is mostly superior to transthoracic echocardiography in diagnosing mural left ventricular thrombi in patients who had suffered a myocardial infarction. Intracavitary thrombi are more frequently found in patients with impaired regional and global left ventricular function.

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PD Dr. Jörg Barkhausen

Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Essen

Hufelandstraße 55

45122 Essen

Phone: 02 01/7 23-15 00

Fax: 02 01/7 23-15 48

Email: joerg.barkhausen@uni-essen.de