Key result
Dual-VENC 4D flow MRI revealed that the absence of blood flow collision from pulmonary veins in the left atrium was significantly associated with thrombus formation after left upper lobectomy.
Why the study?
To clarify left atrial blood flow patterns potentially causing thrombosis formation after left upper lobectomy.
Does Dual-VENC 4D Flow MRI detect abnormal blood flow patterns associated with thrombosis in patients after left upper lobectomy?
Case-Control (n=26)
No
Does Dual-VENC 4D Flow MRI detect abnormal blood flow patterns associated with thrombosis in patients after left upper lobectomy?
Dual-VENC 4D flow MRI identified that the absence of blood flow collision from pulmonary veins in the left atrium is associated with thrombus formation after left upper lobectomy.
Answers are grounded in this paper and cite their sources.
May aid thrombosis risk stratification after left upper lobectomy; leaves open prospective validation of Dual-VENC 4D flow MRI.
PURPOSE: The purpose of the current study was to clarify the blood flow pattern in the left atrium (LA), potentially causing the formation of thrombosis after left upper lobectomy (LUL). The blood flow in the LA was evaluated and compared between LUL patients with and without thrombosis. For the evaluation, we applied highly accelerated 4D flow MRI with dual-velocity encoding (VENC) scheme, which was expected to be able to capture slow flow components in the LA accurately. METHODS: Eight volunteers and 18 patients subjected to LUL underwent dual-VENC 4D Flow MRI. Eight patients had a history of thrombosis. We measured the blood flow velocity and stasis ratio (proportion in the volume that did not exceed 10 cm/s in any cardiac phase) in the LA and left superior pulmonary vein (LSPV) stump. For visual assessment, the presence of each collision of the blood flow from pulmonary veins and vortex flow in the LA were evaluated. Each acquired value was compared between healthy participants and LUL patients, and in LUL patients with and without thrombosis. RESULTS: In LUL patients, blood flow velocity near the inflow part of the left superior pulmonary vein (Lt Upp) and mean velocity in the LA were lower, and stasis ratio in the LA was higher compared with healthy volunteers (Lt Upp 9.10 ± 3.09 vs.13.23 ± 14.19 cm/s, mean velocity in the LA 9.81 ± 2.49 vs. 11.40 ± 1.15 cm/s, and stasis ratio 25.28 ± 18.64 vs. 4.71 ± 3.03%, P = 0.008, 0.037, and < 0.001). There was no significant difference in any quantification values between LUL patients with and without thrombosis. For visual assessment, the thrombus formation was associated with no collision pattern (62.5% vs. 10%, P = 0.019) and not with vortex flow pattern (50% vs. 30%, P = 0.751). CONCLUSION: The net blood flow velocity was not associated with the thrombus formation. In contrast, a specific blood flow pattern, the absence of blood flow collision from pulmonary veins, correlates to the thrombus formation in the LA.
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Nakaza et al. (2021) conducted a case-control in Thrombosis after left upper lobectomy (LUL) (n=26). Dual-VENC 4D Flow MRI vs. LUL patients without thrombosis was evaluated on Absence of blood flow collision pattern in the left atrium (p=0.019). Dual-VENC 4D flow MRI revealed that the absence of blood flow collision from pulmonary veins in the left atrium was significantly associated with thrombus formation after left upper lobectomy.
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