Acute pulmonary embolism with high-intensity signals on magnetic resonance direct thrombus imaging
Acute pulmonary embolism with high-intensity signals on magnetic resonance direct thrombus imaging
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磁共振直接血栓成像高强度信号的急性肺栓塞
DOI：
10.1093/ehjci/jeab123
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Izumiya Yasuhiro
中科院分区：
文献类型：
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作者：
Yamaguchi Tomohiro;Ehara Shoichi;Shibata Atsushi;Yamazaki Takanori;Izumiya Yasuhiro
例1：一名45岁男性突发胸痛被诊断为急性肺栓塞。室内空气中血氧饱和度为96%。经胸超声心动图显示右室功能不全。血液检测显示，D-二聚体水平显著升高，达到9.2gg/mlμ。CT肺血管成像显示双侧主干至段肺动脉有大量血栓(图A)。T1加权磁共振直接血栓成像(MRDTI)显示与肺动脉血栓相对应的高信号(B组)。我们用利伐沙班治疗病人。5个月后复查CT肺血管造影显示肺动脉血栓溶解，MRDTI高信号消失(C、D组)。患者2：1例慢性血栓栓塞性肺动脉高压患者，MRDTI未见高信号(E、F组)。抗凝治疗疗效的分层和急性或慢性PE的鉴别诊断是处理PE患者的重要问题。然而，人们对用于估计血栓年龄的成像技术知之甚少。磁共振弥散张量成像(MRDTI)在评估PE患者的溶栓潜能和鉴别急性和慢性血栓方面的应用尚未见报道。我们的研究结果表明，MRDTI可以有效地对肺血栓的溶解能力进行分层，并区分急性和慢性血栓，这是临床上重要的问题。
Patient 1: A 45-year-old man with sudden chest pain was diagnosed with acute pulmonary embolism (PE). Oxygen saturation was 96% at room air. A transthoracic echocardiogram showed right ventricular dysfunction. A blood test showed a remarkably elevated D-dimer level of 9.2 μg/mL. Computed tomographic pulmonary angiography showed bilateral massive thrombi in the main to segmental pulmonary arteries (Panel A). T1-weighted magnetic resonance direct thrombus imaging (MRDTI) showed high-intensity signals in the area corresponding to thrombi present in the pulmonary arteries (Panel B). We treated the patient using rivaroxaban. Five months later, followup computed tomographic pulmonary angiography showed that thrombi in the pulmonary arteries had dissolved, and highintensity signals on MRDTI had also disappeared (Panels C and D).Patient 2: The thrombus detected by computed tomographic pulmonary angiography in a patient diagnosed as chronic thrombo-embolic pulmonary hypertension did not have high-intensity signals in MRDTI (Panels E and F). Stratification of the efficacy of anticoagulant therapies and differential diagnosis of acute or chronic PE are important concerns in managing patients with PE. However, little is known about the imaging techniques for estimating the age of thrombus. Application of MRDTI for estimating the thrombolytic potential and differentiating between acute and chronic thrombi in patients with PE has not been reported. Our findings suggest that MRDTI is effective for stratifying the dissolving potential of pulmonary thrombi and differentiating between acute and chronic thrombi, which are clinically important concerns.