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Final Program


Program-At-A-Glance

Oral Abstracts Session

Virtual Recording

Session: Oral Abstracts Science Session 2

Left Ventricular Thrombus Assessment Using Joint Bright- and Black-blood LGE Imaging

Friday, February 6, 2026
8:50 AM - 9:00 AM  
Location: Americas I and Hall 3 (2nd Lower Level)

    Presenting Author(s)

  • Aurelien Bustin, FSCMR

    Research Associate
    Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux – INSERM U1045, Avenue du Haut Lévêque, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
    Bordeaux, Aquitaine, France

    • Primary Author(s)

  • Aurelien Bustin, FSCMR

    Research Associate
    Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux – INSERM U1045, Avenue du Haut Lévêque, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
    Bordeaux, Aquitaine, France

    • Co-Author(s)

  • TR

    Théo Richard, MSc

    Engineer
    IHU LIRYC, Heart rhythm disease institute, Université de Bordeaux – INSERM U1045, Avenue du Haut Lévêque, 33604, Pessac, France
    Bordeaux, Aquitaine, France

  • Victor de Villedon de Naide, MSc

    PhD student
    Bordeaux University - INSERM U1045
    Bordeaux, Aquitaine, France

  • EG

    Edouard Gerbaud, MD, PhD

    Cardiac Intensive Care Unit, Groupe Hospitalier Sud, CHU de Bordeaux, Pessac, France, France

  • Thaïs Genisson, MSc

    PhD student
    IHU Liryc, Université de Bordeaux
    Bordeaux, Aquitaine, France

  • Kalvin Narceau, MSc

    Phd student
    Bordeaux University - INSERM U1045
    Pessac, Aquitaine, France

  • EB

    Ewan Barel

    Research engineer
    IHU Liryc, Université de Bordeaux, France

  • PJ

    Pierre Jaïs, MD, PhD

    PROF/PhD
    Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux
    Bordeaux, Aquitaine, France

  • MS

    Matthias Stuber, PhD

    Professor/Director
    CIBM/CHUV/UNIL
    Lausanne, Switzerland

  • HC

    Hubert Cochet, MD, PhD

    Professor
    Bordeaux University - INSERM U1045
    Bordeaux, Aquitaine, France

Background: Left ventricular thrombus (LVT) is a serious complication of structural heart disease, predisposing patients to stroke and systemic embolism. CMR with bright-blood late gadolinium enhancement (LGE) and CINE imaging is more sensitive for LVT detection than echocardiography and guides anticoagulation therapy. Recently, joint bright- and black-blood LGE techniques have enhanced visualization of myocardial scar and papillary muscle infarction (1–3). Given the avascular nature of thrombus, this dual-contrast approach could also enhance LVT detection. We aimed to evaluate the preliminary diagnostic performance of this method for LVT assessment compared with standard imaging.

Methods: We retrospectively included 533 patients undergoing 1.5T CMR (Siemens Aera) for known or suspected structural heart disease. The breath-held protocol comprised standard 2D CINE and PSIR LGE in multiple planes, and the proposed 2D bright- and black-blood SPOT sequence (short-axis only, Fig.1A) (1), 15 min after 0.2 mmol/kg gadoteric acid. Imaging parameters: resolution 1.5x1.5mm2, slice thickness 8mm, TI PSIR: 273±32ms, TI SPOT: 118±30ms. Echocardiography data was not available.

A reader assessed LVT presence independently. On PSIR, LVT was defined as a low-signal LV mass consistent with avascular tissue, surrounded by high-signal blood or hyperenhanced infarcted myocardium. On CINE and bright-blood SPOT, LVT was defined as an intracavitary mass with distinct margins from the endocardium, distinguishable from papillary muscles. When present, maximum thrombus length was measured on short-axis images (CVI42). Diagnostic confidence (not visible, poorly visible, clearly visible) and signal intensities (blood, myocardium, thrombus) were compared. Acquisition times were measured.

Results: LVT was identified in 42 patients (8%). 7 were excluded from analysis due to poor thrombus visibility on one or more short-axis sequences (Fig.1B). The remaining 35 patients had myocardial infarction (N=29), dilated cardiomyopathy (N=4), or both (N=2). Short-axis CINE outperformed PSIR and SPOT for LVT detection (97.6% vs. 76.2% and 78.6%, respectively, Fig.3A). SPOT provided full LV coverage in 3min54s [3min31s–4min18s]. Fig.2A illustrates 6 cases with clear LVT depiction across all sequences, while Fig.2B shows the 7 excluded cases. Thrombus length did not differ across sequences (CINE: 15.4mm [9.5–24.5], PSIR: 15.1mm [9.2–25.8], SPOT: 15.2mm [10.9–24.7], p=0.991, Fig.3C) with excellent correlation (r=0.99, p< 0.01) and negligible bias (< 0.2mm, Fig.3D-F). SPOT achieved significantly greater thrombus-myocardium contrast (p< 0.001) than CINE (p=0.161) or PSIR (p=0.166, Fig.3B).

Conclusion: Joint bright- and black-blood LGE imaging enables accurate LVT assessment while maintaining its proven value for scar and papillary muscle infarction detection. Although current 2D resolution may limit visualization of small apical thrombi, extending this technique to high-resolution 3D imaging could further enhance its clinical utility.

Figure 1. A) Schematic of the joint bright- and black-blood SPOT sequence: odd heartbeats include a 180° inversion pulse followed by adiabatic T1-rho preparation (black-blood contrast); even heartbeats include a T1-rho module only (bright-blood contrast). B) Study flowchart and patient allocation. Abbreviations: CMR = cardiac magnetic resonance; DCM = dilated cardiomyopathy; ECG = electrocardiogram; LAD = left anterior descending artery; LCX = left circumflex artery; MI = myocardial infarction; RCA = right coronary artery; SPOT = scar-specific imaging with preserved myocardial visualization.
Figure 2. Representative examples of left ventricular thrombus visibility. A) Cases with clear thrombus depiction (yellow arrows) across all sequences (CINE, PSIR, SPOT). B) Cases excluded from length analysis due to insufficient thrombus visualization in one or more sequences. SPOT fusion images were generated by color-overlaying the black-blood and bright-blood datasets to combine anatomical and contrast information. Abbreviations: PSIR = phase sensitive inversion recovery; SPOT = scar-specific imaging with preserved myocardial visualization.
Figure 3. Quantitative comparison of LVT measurements between CINE, PSIR, and bright-blood SPOT sequences. A) Proportion of patients and visibility of LVT detected by each sequence. B) Signal intensity analysis for blood, thrombus, and myocardium across sequences. C) Boxplots of thrombus length on each sequence (no significant difference, p=0.991). D)-F) Bland-Altman plots comparing thrombus length across sequences. Abbreviations: CI = confidence interval; LVT = left ventricular thrombus; N.S. = non-significant; PSIR = phase sensitive inversion recovery; SPOT = scar-specific imaging with preserved myocardial visualization.