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. 2013 Feb;98(2):309-15.
doi: 10.3324/haematol.2012.069195. Epub 2012 Jul 16.

Finding the origin of pulmonary emboli with a total-body magnetic resonance direct thrombus imaging technique

Kirsten van Langevelde  1 , Alexandr Srámek, Patrice W J Vincken, Jan-Kees van Rooden, Frits R Rosendaal, Suzanne C Cannegieter
Affiliations

Finding the origin of pulmonary emboli with a total-body magnetic resonance direct thrombus imaging technique

Kirsten van Langevelde et al. Haematologica. 2013 Feb.

Abstract

Pulmonary embolism is considered to originate from embolization of a deep-vein thrombosis, resulting in two manifestations of one disease: venous thrombosis. However, in up to 50% of patients with pulmonary embolism no deep-vein thrombosis is found with ultrasonography. An explanation for this low proportion is currently lacking. Other imaging modalities may increase the yield of detection of deep-vein thrombosis in the calf or in the abdominal region. Alternatively, not all pulmonary emboli may originate from deep-vein thromboses in the extremities. We searched for the origin of pulmonary emboli, by performing total-body magnetic resonance imaging-scans to visualize thrombi. Ninety-nine patients with a first pulmonary embolism confirmed by computed tomography underwent a magnetic resonance direct thrombus imaging-scan, a validated technique using endogenous contrast. Additionally, acquired and genetic risk factors were assessed. No thrombus was found in 55 patients, whereas a thrombus was identified in 44 patients. The commonest thrombus location was the lower leg; 12 patients had isolated calf vein thrombosis and five had isolated superficial vein thrombosis. A peripheral thrombus was found by magnetic resonance imaging in less than half of patients with pulmonary embolism. We propose several hypotheses to explain the absence of thrombi, such as a cardiac thrombus origin or embolization of the whole deep-vein thrombus. The possibility that pulmonary embolism arises de novo in the lungs, due to local inflammation-driven coagulation, needs to be considered.

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Figures

Figure 1.
Figure 1.
Study patients. Flowchart of patients with pulmonary embolism from the Rijnland Hospital and the Leiden University Medical Center (LUMC).
Figure 2.
Figure 2.
Anatomical distribution of thrombi on MRI. Division into seven venous segments with thrombosis in all patients with pulmonary embolism, with a deep-vein thrombosis on magnetic resonance images (N=44).
See this image and copyright information in PMC

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