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CC BY 4.0 · TH Open 2020; 04(03): e224-e230
DOI: 10.1055/s-0040-1716716
Original Article

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

Lisette F. van Dam
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Frederikus A. Klok
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Maarten E. Tushuizen
2   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
,
Walter Ageno
3   Department of Medicine and Surgery, University of Insubria, Varese, Italy
,
Sarwa Darwish Murad
4   Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Guido R. van Haren
5   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
,
Menno V. Huisman
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Mandy N. Lauw
6   Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Antonio Iglesias del Sol
7   Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
,
Martin N.J.M. Wasser
5   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
,
Ysbrand Willink
5   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
,
Lucia J.M. Kroft
5   Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations Funding This study was supported by the Dutch Thrombosis Foundation (2018–04), Gastrostart (2018–47), and the Scientific and Standardization Committee of the International Society on Thrombosis and Hemostasis.
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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.

Keywords

diagnosis - diagnostic imaging - magnetic resonance imaging - venous thrombosis

Authors' Contributions

L.F.v.D., F.A.K., and L.J.M.K. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. L.F.v.D., F.A.K., M.E.T., W.A., S.D.M., G.R.v.H., M.V.H., M.N.L., A.I.d.S., M.N.J.M.W., Y.W., and L.J.M.K. contributed to acquisition of the data. L.F.v.D., F.A.K., and L.J.M.K. contributed to analysis and interpretation of the data. L.F.v.D., F.A.K., M.E.T., and L.J.M.K contributed to drafting of the manuscript. L.F.v.D., F.A.K., M.E.T., W.A., S.D.M., G.R.v.H., M.V.H., M.N.L., A.I.d.S., M.N.J.M.W., Y.W., and L.J.M.K. contributed to critical revision of themanuscript. L.F.v.D., F.A.K., M.E.T., W.A., S.D.M., G.R.v.H., M.V.H., M.N.L., A.I.d.S., M.N.J.M.W., Y.W., and L.J.M.K. contributed to final approval of the manuscript.


Supplementary Material



Publication History

Received: 26 June 2020

Accepted: 04 August 2020

Article published online:
23 September 2020

© .

Georg Thieme Verlag KG
Stuttgart · New York

 

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