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Saha P, Andia ME, Modarai B, Blume U, Humphries J, Patel AS, Phinikaridou A, Evans CE, Mattock K, Grover SP, Ahmad A, Lyons OT, Attia RQ, Renné T, Premaratne S, Wiethoff AJ, Botnar RM, Schaeffter T, Waltham M, Smith A. Magnetic resonance T1 relaxation time of venous thrombus is determined by iron processing and predicts susceptibility to lysis. Circulation 2013; 128:729-736. [PMID: 23820077 DOI: 10.1161/circulationaha.113.001371] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The magnetic resonance longitudinal relaxation time (T1) changes with thrombus age in humans. In this study, we investigate the possible mechanisms that give rise to the T1 signal in venous thrombi and whether changes in T1 relaxation time are informative of the susceptibility to lysis. METHODS AND RESULTS Venous thrombosis was induced in the vena cava of BALB/C mice, and temporal changes in T1 relaxation time correlated with thrombus composition. The mean T1 relaxation time of thrombus was shortest at 7 days following thrombus induction and returned to that of blood as the thrombus resolved. T1 relaxation time was related to thrombus methemoglobin formation and further processing. Studies in inducible nitric oxide synthase (iNOS(-/-))-deficient mice revealed that inducible nitric oxide synthase mediates oxidation of erythrocyte lysis-derived iron to paramagnetic Fe3+, which causes thrombus T1 relaxation time shortening. Studies using chemokine receptor-2-deficient mice (Ccr2(-/-)) revealed that the return of the T1 signal to that of blood is regulated by removal of Fe3+ by macrophages that accumulate in the thrombus during its resolution. Quantification of T1 relaxation time was a good predictor of successful thrombolysis with a cutoff point of <747 ms having a sensitivity and specificity to predict successful lysis of 83% and 94%, respectively. CONCLUSIONS The source of the T1 signal in the thrombus results from the oxidation of iron (released from the lysis of trapped erythrocytes in the thrombus) to its paramagnetic Fe3+ form. Quantification of T1 relaxation time appears to be a good predictor of the success of thrombolysis.
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Affiliation(s)
- Prakash Saha
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Marcelo E Andia
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Bijan Modarai
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Ulrike Blume
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Julia Humphries
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Ashish S Patel
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Alkystis Phinikaridou
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Colin E Evans
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Katherine Mattock
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Steven P Grover
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Anwar Ahmad
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Oliver T Lyons
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Rizwan Q Attia
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Thomas Renné
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Sobath Premaratne
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Andrea J Wiethoff
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - René M Botnar
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Tobias Schaeffter
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Matthew Waltham
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
| | - Alberto Smith
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, UK (P.S., B.M., J.H., A.S.P., C.E.E., K.M., S.P.G., A.A., O.T.L., R.Q.A., S.P., M.W., A.S.); Division of Imaging Sciences and Biomedical Engineering, Kings College London, BHF Centre of Research Excellence & Wellcome Trust - EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, UK (M.E.A., U.B., A.P., A.J.W., T.S.); Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile (M.E.A.); Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital Solna, Stockholm, Sweden (T.R.); and Philips Healthcare, Guildford, UK (A.J.W.)
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