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Gi T, Kuroiwa Y, Yamashita A, Mizutani Y, Asanuma T, Miyati T, Maekawa K, Aman M, Imamura T, Asada Y. High Signal Intensity on Diffusion-Weighted Images Reflects Acute Phase of Deep Vein Thrombus. Thromb Haemost 2020; 120:1463-1473. [PMID: 32746467 PMCID: PMC7511261 DOI: 10.1055/s-0040-1714280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The effects of antithrombotic therapy on deep vein thrombosis (DVT) can be affected by thrombus age, which cannot be reliably determined by noninvasive imaging modalities. We investigated whether magnetic resonance (MR) diffusion-weighted imaging (DWI) can localize and determine the age of venous thrombus in patients with DVT, animal models, and human blood in vitro. Signal intensity (SI) on DWI and the apparent diffusion coefficient (ADC) of thrombi were assessed in eight patients with DVT using a 1.5-T MR imaging (MRI) system. We assessed the organizing processes as venous thrombus developed in the rabbit jugular vein using a 3.0-T MRI system over time. We also assessed MRI signals of human blood in vitro using the 1.5-T MRI system. Venous thrombi were detected by DWI as areas of high or mixed high and iso SI in all patients. The ADCs were lower in the proximal, than in the distal portion of the thrombi. The thrombi of rabbit jugular veins histologically organized in a time-dependent manner, with high SI on DWI at 4 hours, mixed high and iso SI at 1 and 2 weeks, and iso SI at 3 weeks. The ADC correlated negatively with erythrocyte content, and positively with smooth muscle cells, macrophages, hemosiderin, and collagen content. MRI signals of human blood in vitro showed that ADCs were affected by erythrocyte content, but not by blood clotting. MR-DWI can detect venous thrombus, and high SI on DWI accompanied by a low ADC might reflect erythrocyte-rich, acute-phase thrombi.
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Affiliation(s)
- Toshihiro Gi
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yasuyoshi Kuroiwa
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.,Department of Radiological Technology, Koga General Hospital, Miyazaki, Japan
| | - Atsushi Yamashita
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuko Mizutani
- Division of Radiology, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Taketoshi Asanuma
- Development of Veterinary Medicine, Faculty of Veterinary Medicine, Imabari Campus, Okayama University of Science, Imabari, Japan
| | - Tosiaki Miyati
- Institute of Medical, Pharmaceutical and Health Sciences, Faculty of Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Kazunari Maekawa
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Murasaki Aman
- Department of Diagnostic Pathology, University of Miyazaki Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takuroh Imamura
- Department of Internal Medicine, Koga General Hospital, Miyazaki, Japan
| | - Yujiro Asada
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Morani AC, Elsayes KM, Liu PS, Weadock WJ, Szklaruk J, Dillman JR, Khan A, Chenevert TL, Hussain HK. Abdominal applications of diffusion-weighted magnetic resonance imaging: Where do we stand. World J Radiol 2013; 5:68-80. [PMID: 23671743 PMCID: PMC3650207 DOI: 10.4329/wjr.v5.i3.68] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 10/21/2012] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI) is one of the magnetic resonance imaging (MRI) sequences providing qualitative as well as quantitative information at a cellular level. It has been widely used for various applications in the central nervous system. Over the past decade, various extracranial applications of DWI have been increasingly explored, as it may detect changes even before signal alterations or morphological abnormalities become apparent on other pulse sequences. Initial results from abdominal MRI applications are promising, particularly in oncological settings and for the detection of abscesses. The purpose of this article is to describe the clinically relevant basic concepts of DWI, techniques to perform abdominal DWI, its analysis and applications in abdominal visceral MR imaging, in addition to a brief overview of whole body DWI MRI.
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Ichiki M, Sakai Y, Nango M, Nakamura K, Matsui H, Cho H, Kitayama T, Sahara T, Otani N, Inoue Y, Miki Y. Experimental venous thrombi: MRI characteristics with histopathological correlation. Br J Radiol 2012; 85:331-8. [PMID: 22457401 DOI: 10.1259/bjr/37592039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the MRI characteristics of venous thrombus over set time thresholds with histopathological correlation in a porcine model. METHODS Inferior vena cava thrombi were induced in 12 pigs. MRI was performed in three pigs 2 h, 1 day, 3 days and 2 weeks after thrombus induction. RESULTS The MRI characteristics were analysed in correlation with histopathological findings. The thrombi after 2 hours, which consisted of red blood cells (RBCs), showed isointensity on T(1 )weighted images (T(1)WIs) and hyperintensity on both T(2 )weighted images (T(2)WIs) and diffusion-weighted images (DWIs). The mean apparent diffusion coefficient (ADC) value was 1.93 × 10(-3) mm(2) s(-1). The thrombi after Day 1, which consisted of RBCs and migrating neutrophils at the periphery, showed isointensity on T(1)WIs, slight hyperintensity on T(2)WIs and hypointensity on DWIs. The mean ADC value was 1.62 × 10(-3) mm(2) s(-1) [corrected]. The thrombi after Day 3, which consisted of RBCs and peripheral inflammatory cells including macrophages, showed isointensity with peripheral hyperintense regions on T(1)WIs and hypointensity on both T(2)WIs and DWIs. The mean ADC value was 1.67 × 10(-3) mm(2) s(-1). After 2 weeks, the thrombi, which revealed RBC lysis surrounded by granulation tissues, showed isointensity on T(1)WIs and hyperintensity on T(2)WIs and DWIs. The mean ADC value was 2.48 × 10(-3) mm(2) s(-1). CONCLUSION The temporal MRI characteristics seemed to be related to chemical and physical changes in RBC and organisation of granulation tissues. Free radicals generated by macrophages might also be related to some extent.
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Affiliation(s)
- M Ichiki
- Department of Radiology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan.
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Mürtz P, Kaschner M, Träber F, Kukuk G, Skowasch D, Gieseke J, Schild HH, Willinek WA. Diffusion-weighted whole-body MRI with background body signal suppression: Technical improvements at 3.0 T. J Magn Reson Imaging 2011; 35:456-61. [DOI: 10.1002/jmri.22877] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 10/06/2011] [Indexed: 11/07/2022] Open
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Pierce IT, Gatehouse PD, Xu XY, Firmin DN. MR phase-contrast velocity mapping methods for measuring venous blood velocity in the deep veins of the calf. J Magn Reson Imaging 2011; 34:634-44. [PMID: 21761470 DOI: 10.1002/jmri.22655] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 04/28/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the feasibility of using un-gated, real-time MRI for venous blood velocity mapping in the calf, comparing an interleaved spiral k-space sequence (ISP) against a standard segmented gradient echo sequence (GRE). MATERIALS AND METHODS A flow phantom with a variable flow-rate was scanned using both GRE and ISP sequences for an in vitro comparison. Seven subjects were scanned prone, performing metronome guided breathing, using the (externally triggered) segmented GRE and real-time ISP sequences. The segmented GRE acquisition duration was 2.5 mins (22 guided respiratory cycles) and the ISP sequence ran continuously for 35 s, 4 full guided respiratory cycles. Mean velocity from each of the deep veins was measured and peak mean velocity, peak flow rate and cumulative volume flow over a respiratory cycle compared between sequences. RESULTS The two sequences compared well both in vitro and in vivo. The real-time ISP sequence showed short-term variations in mean velocity superimposed on the respiratory induced flow, which were averaged out using the segmented GRE sequence. CONCLUSION Real-time ISP provides comparable time-averaged flow results to the standard sequence with additional information on real-time flow variations and so could be used for further investigation into venous blood flow in the lower leg.
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Affiliation(s)
- Iain T Pierce
- CMR Unit, National Heart and Lung Institute, Imperial College London, United Kingdom.
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Fujii S, Kaneda S, Kakite S, Kanasaki Y, Matsusue E, Harada T, Kaminou T, Ogawa T. Diffusion-weighted imaging findings of adnexal torsion: Initial results. Eur J Radiol 2011; 77:330-4. [DOI: 10.1016/j.ejrad.2009.07.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 06/10/2009] [Accepted: 07/31/2009] [Indexed: 11/26/2022]
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[Whole-body diffusion-weighted magnetic resonance imaging in oncology]. Presse Med 2009; 39:548-52. [PMID: 19932000 DOI: 10.1016/j.lpm.2009.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 09/23/2009] [Accepted: 10/05/2009] [Indexed: 11/21/2022] Open
Abstract
Because of its excellent diagnostic performance, whole-body MRI will probably become an alternative to or replacement for positron emission tomography and computed tomography (PET-CT). The sensitivity of diffusion sequences is high. Whole body MRI is used increasingly often in oncology, for initial or follow-up staging, finding primary tumors after identifying metastases, staging for pregnant woman and children, and therapeutic follow-up. Advantages of whole-body MRI over PET-CT include the absence of irradiation as well as the greater availability, and lower cost of MRI.
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Kwee TC, Takahara T, Ochiai R, Katahira K, Van Cauteren M, Imai Y, Nievelstein RAJ, Luijten PR. Whole-body diffusion-weighted magnetic resonance imaging. Eur J Radiol 2009; 70:409-17. [PMID: 19403255 DOI: 10.1016/j.ejrad.2009.03.054] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 03/26/2009] [Indexed: 01/12/2023]
Abstract
Diffusion-weighted magnetic resonance imaging (DWI) provides information on the diffusivity of water molecules in the human body. Technological advances and the development of the concept of diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) have opened the path for routine clinical whole-body DWI. Whole-body DWI allows detection and characterization of both oncological and non-oncological lesions throughout the entire body. This article reviews the basic principles of DWI and the development of whole-body DWI, illustrates its potential clinical applications, and discusses its limitations and challenges.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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