Download PDF
CC BY 4.0 · TH Open 2024; 08(03): e266-e272
DOI: 10.1055/a-2341-6349
Original Article

Use of Magnetic Resonance Direct Thrombus Imaging for the Diagnostic Management of Suspected Thrombosis in Routine Clinical Practice

Cindy M.M. de Jong
1   Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
,
Lisette F. van Dam
1   Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
2   Department of Emergency Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
,
Charlotte E.A. Dronkers
1   Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
3   Department of Internal Medicine, Haaglanden Medical Center, Den Haag, the Netherlands
,
Jeroen Eikenboom
1   Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
,
Paul L. den Exter
1   Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
,
Sophie N.M. ter Haar
1   Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
,
Guido R. van Haren
4   Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
,
Menno V. Huisman
1   Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
,
Thijs E. van Mens
1   Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
,
J. Lauran Stöger
4   Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
,
Lucia J.M. Kroft
4   Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
,
Frederikus A. Klok 
1   Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background The noninvasive magnetic resonance direct thrombus imaging (MRDTI) technique can be used to diagnose acute deep vein thrombosis (DVT), without the use of intravenous contrast. MRDTI holds the potential to differentiate between acute and chronic DVT and could be helpful when diagnosing thrombosis is challenging.

Objectives Our objective was to evaluate the application of MRDTI in clinical practice, including the frequency and indications of MRDTI scans performed in practice-based conditions, results, impact on treatment decisions, and associated patient outcomes.

Methods A retrospective study was performed at the Leiden University Medical Center, the Netherlands. MRDTI scans performed since its implementation in patients aged ≥18 years as part of clinical practice for the diagnostic management of suspected thrombosis were evaluated.

Results Between October 2015 and September 2023, 36 patients had undergone MRDTI for the diagnostic evaluation of thrombosis. MRDTI application increased since 2019 (five–eight scans per year). The most common indication was to differentiate between acute and chronic thrombosis, mainly for suspected recurrent ipsilateral DVT after inconclusive compression ultrasonography. In over a third of patients, acute thrombosis was confirmed by MRDTI. MRDTI results determined treatment decisions in all except two patients. One patient had symptomatic thrombosis of the lower extremity within 3 months after an MRDTI of the upper extremity without signs of acute thrombosis (1/23; 4.3%, 95% confidence interval: 0.77–21).

Conclusion Over the past 4 years, MRDTI has been used increasingly in our hospital. MRDTI results guided treatment decisions, which confirms the clinical impact and feasibility of its application in daily practice.

Keywords

venous thrombosis - deep vein thrombosis - magnetic resonance imaging - diagnostic imaging - radiology


Publication History

Received: 16 March 2024

Accepted: 06 June 2024

Accepted Manuscript online:
10 June 2024

Article published online:
09 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Moody AR. Direct imaging of deep-vein thrombosis with magnetic resonance imaging. Lancet 1997; 350 (9084) 1073
    CrossrefPubMedGoogle Scholar
  • 2 Moody AR, Pollock JG, O'Connor AR, Bagnall M. Lower-limb deep venous thrombosis: direct MR imaging of the thrombus. Radiology 1998; 209 (02) 349-355
    CrossrefPubMedGoogle Scholar
  • 3 Gautam G, Sebastian T, Klok FA. How to differentiate recurrent deep vein thrombosis from postthrombotic syndrome. Hamostaseologie 2020; 40 (03) 280-291
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Moody AR. Magnetic resonance direct thrombus imaging. J Thromb Haemost 2003; 1 (07) 1403-1409
    CrossrefPubMedGoogle Scholar
  • 5 Westerbeek RE, Van Rooden CJ, Tan M. et al. Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg. J Thromb Haemost 2008; 6 (07) 1087-1092
    CrossrefPubMedGoogle Scholar
  • 6 van Dam LF, Dronkers CEA, Gautam G. et al; Theia Study Group. Magnetic resonance imaging for diagnosis of recurrent ipsilateral deep vein thrombosis. Blood 2020; 135 (16) 1377-1385
    CrossrefPubMedGoogle Scholar
  • 7 van Dam LF, Klok FA, Tushuizen ME. et al. Magnetic resonance thrombus imaging to differentiate acute from chronic portal vein thrombosis. TH Open 2020; 4 (03) e224-e230
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Dronkers CE, Srámek A, Huisman MV, Klok FA. Accurate diagnosis of iliac vein thrombosis in pregnancy with magnetic resonance direct thrombus imaging (MRDTI). BMJ Case Rep 2016; 2016: bcr2016218091
    CrossrefPubMedGoogle Scholar
  • 9 van Dam LF, Dronkers CEA, Gautam G. et al. Detection of upper extremity deep vein thrombosis by magnetic resonance non-contrast thrombus imaging. J Thromb Haemost 2021; 19 (08) 1973-1980
    CrossrefPubMedGoogle Scholar
  • 10 de Jong CMM, Kroft LJM, van Mens TE, Huisman MV, Stöger JL, Klok FA. Modern imaging of acute pulmonary embolism. Thromb Res 2024; 238: 105-116
    CrossrefPubMedGoogle Scholar
  • 11 Fraser DG, Moody AR, Morgan PS, Martel AL, Davidson I. Diagnosis of lower-limb deep venous thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Intern Med 2002; 136 (02) 89-98
    CrossrefPubMedGoogle Scholar
  • 12 Tan M, Mol GC, van Rooden CJ. et al. Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis. Blood 2014; 124 (04) 623-627
    CrossrefPubMedGoogle Scholar
  • 13 van Dam LF, Kroft LJ, Dronkers CE. et al. Magnetic resonance direct thrombus imaging (MRDTI) can distinguish between old and new thrombosis in the abdominal aorta: a case report. Eur J Case Rep Intern Med 2020; 7 (01) 001351
    PubMedGoogle Scholar
  • 14 Moody AR, Murphy RE, Morgan PS. et al. Characterization of complicated carotid plaque with magnetic resonance direct thrombus imaging in patients with cerebral ischemia. Circulation 2003; 107 (24) 3047-3052
    CrossrefPubMedGoogle Scholar
  • 15 Murphy RE, Moody AR, Morgan PS. et al. Prevalence of complicated carotid atheroma as detected by magnetic resonance direct thrombus imaging in patients with suspected carotid artery stenosis and previous acute cerebral ischemia. Circulation 2003; 107 (24) 3053-3058
    CrossrefPubMedGoogle Scholar
  • 16 Bitar R, Moody AR, Leung G. et al. In vivo identification of complicated upper thoracic aorta and arch vessel plaque by MR direct thrombus imaging in patients investigated for cerebrovascular disease. AJR Am J Roentgenol 2006; 187 (01) 228-234
    CrossrefPubMedGoogle Scholar
  • 17 Jansen CH, Perera D, Makowski MR. et al. Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 2011; 124 (04) 416-424
    CrossrefPubMedGoogle Scholar
  • 18 Bates SM, Jaeschke R, Stevens SM. et al. Diagnosis of DVT: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (02) e351S-e418S
    CrossrefPubMedGoogle Scholar
  • 19 Lim W, Le Gal G, Bates SM. et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv 2018; 2 (22) 3226-3256
    CrossrefPubMedGoogle Scholar
  • 20 van Dam LF, van den Hout WB, Gautam G. et al. Cost-effectiveness of magnetic resonance imaging for diagnosing recurrent ipsilateral deep vein thrombosis. Blood Adv 2021; 5 (05) 1369-1378
    CrossrefPubMedGoogle Scholar