Detection of Intracoronary Thrombus by Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction
Detection of Intracoronary Thrombus by Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction
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DOI：
10.1161/circulationaha.110.965442
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发表时间：
2011-07-26
期刊：
影响因子：
37.8
通讯作者：
Botnar, R. M.
中科院分区：
文献类型：
--
作者：
Jansen, C. H. P.;Perera, D.;Botnar, R. M.
背景-斑块破裂后持续性冠状动脉内血栓与随后心肌梗死和死亡风险增加相关。冠状动脉血栓通常通过X射线冠状动脉造影术有创地可视化。非对比增强T1加权磁共振（MR）成像已被用于直接成像颈动脉血栓和斑块内出血的优势，存在于急性血栓和斑块内出血的高铁血红蛋白的短T1。本研究的目的是探讨非对比增强MR直接血栓成像（MRDTI）在急性心肌梗死患者中的应用。（14名男性;年龄61 +/- 9岁）在出现急性冠状动脉综合征后24 - 72小时内进行了MRDTI检查，然后进行了侵入性X线冠状动脉造影; MRDTI采用T1加权、三维、反转恢复黑血梯度回波序列，无造影剂。X线冠状动脉造影发现10例冠状动脉内血栓（左前降支4例，左回旋支2例，右冠状动脉4例，右冠状动脉-后降支1例），8例未见血栓。我们发现，MRDTI正确地识别了9/10例患者的血栓（敏感性，91%;未检测到后降支动脉血栓），并正确地分类了8例无血栓形成的患者中的7例对照组（特异性，88%）。对比噪声比显着更大的冠状动脉段含有血栓（n = 10）相比，没有明显的血栓（n = 131;平均对比噪声比，15.9比2.6; P < 0.001）。结论：使用MRDTI允许选择性可视化冠状动脉血栓的患者人群与冠状动脉内血栓形成的可能性很高。（循环。2011; 124：416-424.）
Background-Persistent intracoronary thrombus after plaque rupture is associated with an increased risk of subsequent myocardial infarction and mortality. Coronary thrombus is usually visualized invasively by x-ray coronary angiography. Non-contrast-enhanced T1-weighted magnetic resonance (MR) imaging has been useful for direct imaging of carotid thrombus and intraplaque hemorrhage by taking advantage of the short T1 of methemoglobin present in acute thrombus and intraplaque hemorrhage. The aim of this study was to investigate the use of non-contrast-enhanced MR for direct thrombus imaging (MRDTI) in patients with acute myocardial infarction.Methods and Results-Eighteen patients (14 men; age, 61 +/- 9 years) underwent MRDTI within 24 to 72 hours of presenting with an acute coronary syndrome before invasive x-ray coronary angiography; MRDTI was performed with a T1-weighted, 3-dimensional, inversion-recovery black-blood gradient-echo sequence without contrast administration. Ten patients were found to have intracoronary thrombus on x-ray coronary angiography (left anterior descending, 4; left circumflex, 2; right coronary artery, 4; and right coronary artery-posterior descending artery, 1), and 8 had no visible thrombus. We found that MRDTI correctly identified thrombus in 9 of 10 patients (sensitivity, 91%; posterior descending artery thrombus not detected) and correctly classified the control group in 7 of 8 patients without thrombus formation (specificity, 88%). The contrast-to-noise ratio was significantly greater in coronary segments containing thrombus (n = 10) compared with those without visible thrombus (n = 131; mean contrast-to-noise ratio, 15.9 versus 2.6; P < 0.001).Conclusion-Use of MRDTI allows selective visualization of coronary thrombus in a patient population with a high probability of intracoronary thrombosis. (Circulation. 2011; 124: 416-424.)