Lisette van Dam

Chapter 9 150 MRDTI may prove useful to overcome diagnostic challenges in the arterial system too, but the technique has not been extensively studied in this setting. In a preliminary study, 14 patients with acute limb ischemia were evaluated with MR angiography and MRDTI. MRDTI showed a positive signal in 11 (79%) patients. In 6 patients MRDTI findings were discrepant in thrombus length and occlusion compared to MR angiography. Since recanalization with thrombolysis in these 6 patients was not achieved, it was suggested that the discrepancy reflected a difference between chronic arterial disease and superimposed acute thrombosis. 8 MRDTI was also suggested to be useful in identifying complicated plaques in the carotid arteries and upper thoracic aorta in patients with cerebral vascular disease. 9,10 MRDTI has not yet been evaluated as a tool to guide anticoagulant treatment in abdominal aortic thrombosis. Because of the associated morbidity and mortality of complicated aortic ILT, accurate diagnosis of an unstable thrombus or differentiation between acute versus chronic thrombosis remains very relevant for selected patients. We present the case of a patient who was diagnosed with AAA and extensive wall thrombosis in whom acute and unstable thrombosis could be excluded with MRDTI. MRDTI may therefore be a valuable additional imaging test to establish a definitive diagnosis and treatment in patients with abdominal aortic thrombosis with or without co-existing aortic pathology. More diagnostic studies are needed to support our findings.