In another study, sensitivity, specificity, and diagnostic accuracy of unenhanced steady-state free precession MRA were 100% for the detection of thoracic aorta pathology compared to a contrast-enhanced MRA reference standard; however, this analysis only included 1 case of mural thrombus [43]. Data comparing MRA of the chest to other imaging modalities are lacking. MRI Heart Function and Morphology Without and With IV Contrast Cardiac MR is a noninvasive imaging study that can detect intracardiac thrombus as well as valvular and neoplastic pathologies. A meta-analysis of 7 studies showed that delayed contrast-enhanced cardiac MR had a pooled sensitivity of 100% and a specificity of 99% for detecting left atrial and left atrial appendage thrombus in patients with atrial fibrillation [45]. In another meta-analysis, there was no significant difference in sensitivity and specificity between cardiac CT and cardiac MR in the detection of left atrial appendage thrombus [29]. Contrast-enhanced cardiac MR had a sensitivity of 88% and a specificity of 99% compared to surgical or pathological confirmation of left ventricular thrombus [46]. Cardiac MR is also an accurate imaging modality for the evaluation of valvular disease, including aortic and mitral valve vegetations, which can dislodge and result in arterial embolism [37,47]. Additionally, cardiac MR offers detailed soft tissue characterization for the analysis of benign and malignant intracardiac neoplasms [39,48]. MRI Heart Function and Morphology Without IV Contrast Cardiac MR without contrast provides a detailed anatomic evaluation of the heart chambers. In the workup of embolic sources, the primary role of cardiac MR is in the identification of intracardiac thrombus. A meta-analysis of 7 studies showed that cine cardiac MR had a pooled sensitivity of 91% and a specificity of 93% for detecting left atrial and left atrial appendage thrombus in patients with atrial fibrillation [45].
Workup of Noncerebral Systemic Arterial Embolic Source. In another study, sensitivity, specificity, and diagnostic accuracy of unenhanced steady-state free precession MRA were 100% for the detection of thoracic aorta pathology compared to a contrast-enhanced MRA reference standard; however, this analysis only included 1 case of mural thrombus [43]. Data comparing MRA of the chest to other imaging modalities are lacking. MRI Heart Function and Morphology Without and With IV Contrast Cardiac MR is a noninvasive imaging study that can detect intracardiac thrombus as well as valvular and neoplastic pathologies. A meta-analysis of 7 studies showed that delayed contrast-enhanced cardiac MR had a pooled sensitivity of 100% and a specificity of 99% for detecting left atrial and left atrial appendage thrombus in patients with atrial fibrillation [45]. In another meta-analysis, there was no significant difference in sensitivity and specificity between cardiac CT and cardiac MR in the detection of left atrial appendage thrombus [29]. Contrast-enhanced cardiac MR had a sensitivity of 88% and a specificity of 99% compared to surgical or pathological confirmation of left ventricular thrombus [46]. Cardiac MR is also an accurate imaging modality for the evaluation of valvular disease, including aortic and mitral valve vegetations, which can dislodge and result in arterial embolism [37,47]. Additionally, cardiac MR offers detailed soft tissue characterization for the analysis of benign and malignant intracardiac neoplasms [39,48]. MRI Heart Function and Morphology Without IV Contrast Cardiac MR without contrast provides a detailed anatomic evaluation of the heart chambers. In the workup of embolic sources, the primary role of cardiac MR is in the identification of intracardiac thrombus. A meta-analysis of 7 studies showed that cine cardiac MR had a pooled sensitivity of 91% and a specificity of 93% for detecting left atrial and left atrial appendage thrombus in patients with atrial fibrillation [45].