First pass perfusion imaging to improve the assessment of left ventricular thrombus following a myocardial infarction

Purpose: To assess whether a first-pass perfusion sequence (FPP) improved the detection of left ventricular thrombus (LVT). Materials and methods: Three hundred and twenty-nine patients with a first STEMI were prospectively included to undergo cardiac magnetic resonance (CMR) at baseline and after a 3-month follow-up. A CMR delayed analysis was performed by three blinded examiners (2 CMR experts and 1 novice) according to a two-step reading protocol. First, an analysis was performed on cine CMR and late gadolinium enhancement (routine stage). Then, the FPP stage was performed following initial protocol along with a FPP sequence. Results: LVT was found in 31 out of a total of 638 (4.9%) CMR scans, affecting 30 (9.1%) individuals. All were located in the left ventricular apex. The FPP stage improved significantly the LVT diagnosis for all readers, in 10 and 13 cases (32% and 42%) of LVT suspicion for the experts and 16 cases (41%) for the novice. Respectively 1, 2 and 6 LVT were not detected during the routine stage by the CMR experts and the novice. For the novice, the FPP stage improved diagnosis sensitivity from 78.1 to 91.2%. Conclusions: The prevalence of LVT following a myocardial infarction reached 9.1% and increased with the reading of FPP sequence. The FPP stage improved expert diagnostic certitude and the novice's abilities to reach expert level. (C) 2016 Elsevier Ireland Ltd. All rights reserved.