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(Stroke. 2003;34:2436.)
© 2003 American Heart Association, Inc.

Original Contributions

Comparison of Magnetic Resonance Imaging and Transesophageal Echocardiography in Detection of Thrombus in the Left Atrial Appendage

Hideo Ohyama, MD; Naohisa Hosomi, MD; Tsutomu Takahashi, MD; Katsufumi Mizushige, MD; Kunihiko Osaka, MD; Masakazu Kohno, MD James A. Koziol, PhD

From the Second Department of Internal Medicine, Kagawa Medical University (H.O., N.H., T.T., K.M., M.K.) and Osaka Neurosurgical Hospital (K.O.), Kagawa, Japan, and Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, Calif.

Reprint requests to Naohisa Hosomi, MD, PhD, Second Department of Internal Medicine, Kagawa Medical University, 1750-1 Ikenobe, Miki-Cho, Kagawa 761-0793, Japan. E-mail naohisa{at}kms.ac.jp

Background and Purpose— A noninvasive technique of visualizing the left atrial appendage (LAA) and its thrombus in patients with atrial fibrillation would be of great interest. This study examined the utility of MRI for the assessment of thrombus in the LAA.

Methods— We evaluated 50 subjects with nonrheumatic continuous atrial fibrillation and a history of cardioembolic stroke. Each patient received an MRI and a transesophageal echocardiography (TEE) on the same day for thrombus detection in the LAA. Both double- and triple-inversion recovery sequences were used for the MRI evaluations.

Results— In all subjects, the LAA was readily visualized with MRI. High-intensity masses in the LAA were clearly distinguishable from the LAA wall in the triple–inversion recovery sequences. Concordance between detection of high-intensity mass with MRI and thrombus with TEE was high: no mass (MRI), no thrombus (TEE), 31 patients; mass (MRI), thrombus (TEE), 16 patients; and mass (MRI), no thrombus (TEE), 3 patients (overall =0.876, SE=0.068).

Conclusions— MRI is a noninvasive and reproducible modality for thrombus detection in the LAA of patients with nonrheumatic continuous atrial fibrillation and previous cardioembolic stroke.

Key Words: atrial fibrillation • magnetic resonance imaging • stroke, cardioembolic • thrombi

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