Cine gradient refocused echo (GRE) imaging of intravascular masses: differentiation between tumor and nontumor thrombus.

Overview

Spin echo MR imaging has not permitted reliable differentiation between intraluminal blood clot and tumor thrombus. This study assessed the role of ECG referenced repetitive gradient refocused echo (cine GRE) imaging for the differentiation of intravascular tumor from blood clot. Cine GRE images were reviewed in 23 patients, 11 of whom had intravascular tumor and 12 of whom had intravascular blood clots. Percentage contrast between the lesion and skeletal muscle as the reference tissue was determined from a subjective review of the images and objective signal intensity measurements. Intravascular clots were found to be lower in signal intensity than muscle (mean -55 +/- 29%). Intravascular tumors showed higher signal intensity relative to muscle (mean +17 +/- 9%) with the exception of myxomas (n = 2), which had signal intensity values relative to muscle as low as clots (mean -41 +/- 17%). Three masses in the inferior vena cava were composed of central tumor and peripheral clot; the two components could be differentiated with cine GRE imaging. Cine GRE imaging provides adequate signal intensity differences to visualize intravascular masses and helps to differentiate intravascular clot from tumor thrombus. However, if the tumor contains substantial amounts of iron, then the signal is also low and consequently clot and thrombus may not be distinguishable. This can occur in some atrial myxomas.