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(Circulation. 2005;112:396-399.)
© 2005 American Heart Association, Inc.

Imaging

Molecular Magnetic Resonance Imaging of Atrial Clots in a Swine Model

Elmar Spuentrup, MD; Bernd Fausten, MD; Sylvia Kinzel, VD; Andrea J. Wiethoff, PhD; Rene M. Botnar, PhD; Philip B. Graham, PhD; Stephan Haller, MD; Marcus Katoh, MD; Edward C. Parsons, Jr, PhD; Warren J. Manning, MD; Thomas Busch, MD; Rolf W. Günther, MD; Arno Buecker, MD

From the Departments of Diagnostic Radiology (E.S., S.H., M.K., R.W.G., A.B.), Thoracic and Cardiovascular Surgery (B.F., T.B.), and Laboratory Animal Science (S.K.), Aachen Technical University, Aachen, Germany; EPIX Pharmaceuticals (A.J.W., P.B.G., E.C.P.), Cambridge, Mass; and the Departments of Medicine, Cardiovascular Division (R.M.B., W.J.M.), and Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass.

Reprint requests to Elmar Spuentrup, MD, Department of Diagnostic Radiology, University Hospital, Aachen Technical University, Pauwelsstrasse 30, 52057 Aachen, Germany. E-mail spuenti{at}rad.rwth-aachen.de

Received December 17, 2004; revision received March 2, 2005; accepted March 8, 2005.

Background— The detection and differentiation of intracardiac masses is still challenging and may include neoplasms and thrombi. The aim of this study was the investigation of a targeted, fibrin-specific contrast agent (EP-2104R) for molecular targeted magnetic resonance imaging (MRI) of left atrial clots.

Methods and Results— Chronic human thrombi were surgically implanted in the left atrial appendage of 5 swine. Molecular MRI was performed with a navigator-gated, free-breathing, cardiac-triggered 3D inversion-recovery, black-blood, gradient-echo sequence before and after systemic administration of 4 µmol/kg EP-2104R. MR images were analyzed by 2 investigators, and the contrast-to-noise ratio was calculated. Location of clots was confirmed by autopsy, and the gadolinium concentration in the clots was assessed. Before contrast agent administration, thrombi were not visible on black-blood MR images. After contrast administration, all atrial clots (n=5) were selectively visualized as white spots with a high contrast-to-noise ratio (clot/blood, 29.7±8.0). The gadolinium concentration in the clots averaged 74±45 µmol/L.

Conclusions— The fibrin-specific MR contrast agent EP-2104R allows for selective and high-contrast visualization of left atrial clots by means of molecular targeted MRI.

Key Words: arrhythmia • atrium • imaging • fibrin • thrombus

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