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CC BY-NC-ND 4.0 · Thromb Haemost 2023; 123(04): 453-463
DOI: 10.1055/s-0043-1760846
Stroke, Systemic or Venous Thromboembolism

Thrombus Signal on T1-Weighted Black-Blood MR Predicts Outcomes of Catheter-Directed Thrombolysis in Acute Deep Vein Thrombosis

Chen Huang   †
1   Department of Minimally Invasive Interventional Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
,
Xueping He   †
2   Department of Radiology, Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, China
,
Yueyuan Xie   †
3   Department of Anesthesiology, Mindong Hospital, Ningde, China
,
Hanwei Chen
1   Department of Minimally Invasive Interventional Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
,
Yufeng Ye
2   Department of Radiology, Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou, China
,
Yi Sun
4   Siemens Healthineers, Shanghai, China
,
Rohan Dharmakumar
5   Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Robert K. Ryu
6   Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Debiao Li
5   Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Guoxi Xie
7   Department of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
,
Zhaoyang Fan
6   Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
› Author Affiliations Funding This work was supported in part by the National Natural Science Foundation of China (81971607, 81729003), the Guangdong Medical Science and Technology Research Foundation (B2021376), Guangzhou Science and Technology Planning Project (202103000002), and Panyu Major Science Technology Planning Project (2020-Z04-002).
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Abstract

Objectives Catheter-directed thrombolysis (CDT) is an effective therapy for acute deep vein thrombosis (DVT). However, predicting the CDT outcomes remains elusive. We hypothesized that the thrombus signal on T1-weighted black-blood magnetic resonance (MR) can provide insight into CDT outcomes in acute DVT patients.

Methods A total of 117 patients with acute iliofemoral DVT were enrolled for T1-weighted black-blood MR before CDT in this prospective study. Based on the signal contrast between thrombus and adjacent muscle, patients were categorized into the iso-intense thrombus (Iso-IT), hyper-intense thrombus (Hyper-IT), and mixed iso-/hyper-intense thrombi (Mixed-IT) groups. Immediate treatment outcome (i.e., vein patency) and long-term treatment outcome (i.e., the incidence rate of postthrombotic syndrome) were accessed by the same expert. Histological analysis and iron quantification were performed on thrombus samples to characterize the content of fibrin, collagen, and the ratio of Fe3+ to total iron.

Results Compared to Mixed-IT and Hyper-IT groups, the Iso-IT group had the best lytic effect (90.5 ± 1.6% vs. 78.4 ± 2.6% vs. 46.5 ± 3.3%, p < 0.001), lowest bleeding ratio (0.0 vs. 11.8 vs. 13.3, p < 0.001), and the lowest incidence rate of postthrombotic syndrome on 24 months (3.6 vs. 18.4 vs. 63.4%, p < 0.001) following CDT. The Iso-IT group had a significantly lower ratio of Fe3+ to total iron (93.1 ± 3.2% vs. 97.2 ± 2.1%, p = 0.034) and a higher content of fibrin (12.5 ± 5.3% vs. 4.76 ± 3.18%, p = 0.023) than Hyper-IT.

Conclusion Thrombus signal characteristics on T1-weighted black-blood MR is associated with CDT outcomes and possesses potential to serve as a noninvasive approach to guide treatment decision making in acute DVT patients.

Key Points

  • Thrombus signal on T1-weighted black-blood MR is associated with lytic therapeutic outcome in acute DVT patients.

  • Presence of iso-intense thrombus revealed by T1-weighted black-blood MRI is associated with successful thrombolysis, low bleeding ratio, and low incidence of the postthrombotic syndrome.

  • T1-weighted thrombus signal characteristics may serve as a noninvasive imaging marker to predict CDT treatment outcomes and therefore guide treatment decision making in acute DVT patients.

Keywords

deep vein thrombosis - magnetic resonance imaging - thrombolytic treatment - postthrombotic syndrome

Clinical Trial Registration

URL: http://www.chictr.org.cn.


Unique identifier

ChiCTR1900023986.


Data Availability Statement

The datasets analyzed for the current study are available from the corresponding author on request.


Ethics Approval and Consent to Participate

This study was approved by both institutional review boards of Guangzhou Panyu Central Hospital (K20150030 and H20170024). Besides, consent informs were obtained from all participants.


Authors' Contribution

C.H. and G.X. designed the research; C.H., X.H, Y.X., Y.Y., and Y.S. performed the research; C.H., G.X., X.H., Y.X., and H.C. analyzed and interpreted data; C.H., X.H., Y.X., G.X., Z.F., R.D, R.K.R., and D.L. wrote the manuscript, and all authors approved the final version of the manuscript.


† These authors have equal contributions to the work.


Supplementary Material



Publication History

Received: 15 September 2022

Accepted: 29 November 2022

Article published online:
08 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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