scholarly journals Magnetic Resonance Thrombus Imaging to Differentiate Acute from Chronic Portal Vein Thrombosis

TH Open ◽  
2020 ◽  
Vol 04 (03) ◽  
pp. e224-e230
Author(s):  
Lisette F. van Dam ◽  
Frederikus A. Klok ◽  
Maarten E. Tushuizen ◽  
Walter Ageno ◽  
Sarwa Darwish Murad ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Test Performance ◽  
Expert Panel ◽  
Three Dimensional ◽  
Acute Thrombosis ◽  
Vein Thrombosis ◽  
Thrombus Imaging ◽  
Enhanced Computed Tomography

Abstract Introduction Timely diagnosis and treatment of portal vein thrombosis (PVT) is crucial to prevent morbidity and mortality. However, current imaging tests cannot always accurately differentiate acute from chronic (nonocclusive) PVT. Magnetic resonance noncontrast thrombus imaging (MR-NCTI) has been shown to accurately differentiate acute from chronic venous thrombosis at other locations and may also be of value in the diagnostic management of PVT. This study describes the first phase of the Rhea study (NTR 7061). Our aim was to select and optimize MR-NCTI sequences that would be accurate for differentiation of acute from chronic PVT. Study Design The literature was searched for different MRI sequences for portal vein and acute thrombosis imaging. The most promising sequences were tested in a healthy volunteer followed by one patient with acute PVT and two patients with chronic PVT, all diagnosed on (repetitive) contrast-enhanced computed tomography (CT) venography to optimize the MR-NCTI sequences. All images were evaluated by an expert panel. Results Several MR-NCTI sequences were identified and tested. Differentiation of acute from chronic PVT was achieved with 3D T1 TFE (three-dimensional T1 turbo field echo) and 3D T1 Dixon FFE (three-dimensional T1 fast field echo) sequences with best image quality. The expert panel was able to confirm the diagnosis of acute PVT on the combined two MR-NCTI sequences and to exclude acute PVT in the two patients with chronic PVT. Conclusion Using 3D T1 TFE and 3D T1 Dixon FFE sequences, we were able to distinguish acute from chronic PVT. This clinical relevant finding will be elucidated in clinical studies to establish their test performance.

scholarly journals Splenic and portal vein thrombosis following laparoscopic splenectomy in a pediatric patient with chronic myeloid leukemia

2006 ◽  
Vol 124 (5) ◽  
pp. 275-277 ◽  
Author(s):  
Henrique Manoel Lederman ◽  
Evan Fieldston
Keyword(s):  
Magnetic Resonance ◽  
Chronic Myeloid Leukemia ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Laparoscopic Splenectomy ◽  
Myeloid Leukemia ◽  
Rare Complication ◽  
Marrow Transplant ◽  
Vein Thrombosis ◽  
Increased Risk

CONTEXT: Splenic or portal vein thrombosis is a rare complication following splenectomy. CASE REPORT: We report a case of splenic and portal venous thrombosis in a 10-year-old girl with chronic myeloid leukemia who underwent laparoscopic splenectomy prior to bone marrow transplant. Clinical suspicion of such thrombosis should be high for patients who have had splenectomy. The diagnosis is confirmed by Doppler ultrasound or contrast-enhanced computed tomography; magnetic resonance imaging magnetic resonance angiography or arteriography can also be used. Proposals for postoperative screening protocols are discussed. Patients with primary myeloproliferative disorders are at increased risk of portal vein thrombosis, independent of surgical intervention, perhaps due to platelet dysfunction resulting from abnormalities of pluripotent stem cells. Marked splenomegaly (with larger draining veins) is thought to increase the risk of thrombosis.

Accuracy of Magnetic Resonance Direct Thrombus Imaging (MRDTI) As a Novel Tool in the Diagnosis of Acute Ipsilateral Recurrent Deep Vein Thrombosis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 395-395
Author(s):  
Melanie Tan ◽  
Gerben C Mol ◽  
Marcel A Van de Ree ◽  
Cornelis J Van Rooden ◽  
Robin E Westerbeek ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Magnetic Resonance ◽  
Ultrasound Examination ◽  
Kappa Statistics ◽  
Acute Thrombosis ◽  
Vein Thrombosis ◽  
Thrombus Imaging ◽  
Recurrent Deep Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Abstract Abstract 395 Background Accurate diagnostic assessment of suspected acute ipsilateral recurrent deep vein thrombosis (DVT) is of high clinical importance, however discriminating residual thrombosis from acute recurrent DVT may be challenging. It is known that in 32% of the patients with a suspected acute ipsilateral recurrent DVT the ultrasound examination are non-conclusive. Despite this, patients were treated with indefinite anticoagulant therapy, indicating overtreatment in this group of patients (Tan M et al. J Thromb Haemost 2010). A non-invasive MR technique (Magnetic Resonance Direct Thrombus Imaging (MRDTI), without need for intravenous contrast agent, showed high sensitivity and specificity for diagnosing a first acute DVT (Fraser et al Ann Intern Med 2002). Furthermore the high signal associated with acute thrombosis was not detected 6 months after the initial acute thrombosis, making MRDTI potential relevant for distinguishing a recurrent DVT from a residual thrombosis (Westerbeek RE et al J Thromb Haemost 2008). This study evaluated the accuracy of MRDTI in patients with an acute ipsilateral recurrent DVT and patients with residual thrombosis. Patients/Methods In total 84 patients were enrolled. Of these, 42 consecutive patients had an acute ipsilateral recurrent DVT according to the current ultrasound examination standards in combination with a positive D-dimer test (≥ 500 μg/L); all patients were treated with anticoagulants. Furthermore, 42 patients were without acute signs and symptoms, however had a residual thrombosis on ultrasound examination in combination with a negative D-dimer test (< 500 μg/L). All patients received a MR examination within 48 hours of presentation. MR images were assessed in a blinded fashion by two radiologists. Sensitivity, specificity and interobserver variability were calculated. Results The images of two patients with ipsilateral recurrent DVT were not interpretable, one patient had a knee prosthesis that gave artifacts and in the other patient not the venous system of interest was imaged. The images of 40 patients with an ipsilateral recurrent DVT and of 42 patients with residual thrombosis were fully interpretable. Sensitivity was 86% (95% CI, 71 –94%) and specificity was 100% (95% CI, 89–100%) for MRDTI by the first observer; sensitivity was 88% (95% CI, 74–96%) and specificity was 100% (89–100%) by the second observer. The interobserver agreement between both observers was excellent, with a kappa statistics of 0.97 (95% CI, 0.92 – 1.0). Conclusion Our study shows reasonable sensitivity and very good specificity figures with an excellent observer agreement for imaging an ipsilateral recurrent DVT and residual thrombosis with MRDTI. The sensitivity is somewhat lower than expected; a reason could be that patients with inconclusive ultrasounds were considered as acute recurrent thrombosis by the attending physician, while in fact they had a residual thrombosis. We conclude that MRDTI has good potential in distinguishing a residual thrombosis from an acute recurrent DVT and could therefore be of high value for the diagnosis of patients with suspected acute ipsilateral recurrent DVT. This should however be further evaluated in a management outcome study in which treatment decisions are based on the results of MR. Acknowledgment This study was supported by the Netherlands Heart Foundation (grant no. 2007B146) Disclosures: No relevant conflicts of interest to declare.

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