Karla Maria Treitl MD, Presenter: Nothing to Disclose

Marcus Treitl MD, Abstract Co-Author: Nothing to Disclose

Nora Navina Kammer MD, Abstract Co-Author: Nothing to Disclose

Eva Maria Coppenrath MD, Abstract Co-Author: Nothing to Disclose

Elena Suderland, Abstract Co-Author: Nothing to Disclose

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Tobias Saam MD, Abstract Co-Author: Research Grant, Diamed Medizintechnik GmbH Research Grant, Bayer AG

To evaluate the feasibility of a novel T1w three-dimensional (3D) isotropic-resolution turbo spin-echo (TSE) technique for the diagnosis of deep vein thrombosis (DVT) in comparison to contrast-enhanced magnetic resonance imaging (CE-MRI).

Nine consecutive patients with proven DVT in compression duplex ultrasound (CDUS) and 2 patients with pulmonary embolism and suspicion for DVT (6 male, 17-93 years) were imaged at 3.0 T using 0.75-mm isotropic-resolution TSE (3D) Volumetric ISotropic TSE Acquisition (VISTA) using standard body coils. Thrombus signal (SNRthrombus) and thrombus signal-to-noise-ratio (SNRthrombus), sensitivity (SE), specificity (SP), positive and negative predictive values (PPV, NPV), Cohen`s kappa (κ) and accuracy of VISTA-MRI were calculated using contrast-enhanced MRI (CE-MRI) as a standard of reference. Image quality and diagnostic confidence were assessed on a four-point scale.

The image quality of CE-MRI was significantly better than VISTA-MRI (3.56 ± 0.55 vs. 3.64 ± 0.57, P<0.013); the diagnostic confidence level did not differ significantly (3.87 ± 0.37 vs. 3.83 ± 0.50; P=0.06). VISTA-MRI provided 26.8% and 17.3% improvement in Sthrombus and SNRthrombus. Using CE-MRI as gold standard, there was high agreement with 3D- VISTA images for the detection of DVT, with κ=0.99 for reader I and κ=0.97 for reader II (both P<0.001). This resulted in SE, SP, PPV, NPV and accuracy of 100.0%, 99.6%, 97.6%, 100,0% and 99.7% for reader I and 97.6%, 99.6%, 97.6%, 99.6% and 99.3% for reader II. Comparing CDUS and VISTA-MRI there was less agreement with κ=0.78 (P<0.001) and 81.0%, 95.4%, 87.9%, 92,2% and 91.1% for both readers after a spare time of 4,1 (0-10) days.

3D-T1w-VISTA-MRI is able to diagnose DVT with excellent agreement compared to CE-MRI and good agreement compared to CDUS and might be useful when use of contrast media is prohibited and in patients with suspected thrombosis of the iliac veins, which can be hard to detect in sonography.

• Black blood MRI using a high-resolution T1-weighted 3D-VISTA sequence allows the diagnosis of deep vein thrombosis. • Black blood MRI allows the diagnosis of deep vein thrombosis without the application of contrast medium. • Black blood MRI could be a valid alternative in pregnant patients, in patients with renal insufficiency or in patients / vessels, which cannot be examined with sufficient quality in duplex sonography.  

Treitl, K, Treitl, M, Kammer, N, Coppenrath, E, Suderland, E, Reiser, M, Saam, T, Three-dimensional T1- and T2-weightet Turbo Spin-echo Technique: A Viable Alternative to Contrast-enhanced MRI for the Diagnosis of Deep Vein Thrombosis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003446.html