- Meeting abstract
- Open Access
1016 Increased sensitivity for detection of intra-cardiac thrombus using phase sensitive inversion recovery (PSIR) late enhancement techniques for combined myocardial scar and thrombus imaging
© Peter et al; licensee BioMed Central Ltd. 2008
- Published: 22 October 2008
- Normal Myocardium
- Myocardial Scar
- Left Atrial Appendage Thrombus
- Phase Sensitive Inversion Recovery
- Thrombus Imaging
Late enhancement techniques have been recently used for the detection of intra-cardiac thrombus due to its characteristic appearance in DE images. For time reasons in clinical practice frequently a TI is chosen which nulls the normal myocardium and not the thrombus allowing simultaneous evaluation of myocardial scar and thrombus. This work demonstrates the pitfalls of solely magnitude based DE imaging for the simultaneous detection of intra-cardiac thrombus and shows the benefits of the PSIR technique by theoretical and clinical analysis
In Phase-Sensitive-Inversion-Recovery (PSIR) techniques the reconstructed image discriminates between positive and negative signal amplitudes. Thus PSIR reduces the need to set precise inversion times to avoid reduced or even inverted contrast between areas of hyper-enhancement and normal myocardium .
The theoretical benefits in the use of a PSIR method as a robust method to depict intra-cardiac thrombus within a single DE study are validated in-vivo. In magnitude images the contrast between thrombus and contrast-enhanced blood is compromised in the range of TI values typically used in DE to null the myocardium and small thrombi could remain undetected. Non-PSIR methods require additional scans with optimized TI times to maximize sensitivity to thrombus.
A pilot study recently described the use of DE techniques for detection of left atrial appendage thrombus  and reported a low sensitivity (44%) using a non-PSIR technique. The range of TI values suggests that the optimization was for myocardial nulling which results in the compromised contrast illustrated above. The use of a PSIR-technique should result in increased sensitivity in detection of LAA and other intra-cardiac thrombi without the need for an additional scan or optimization of TI-times.
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