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• Clinical Article •
Value of multiparametric MR black-blood thrombus imaging in staging diagnosis of lower extremity deep vein thrombosis
ZHANG Ling  PENG Ruchen  WANG Peng  LI Yancui  LIU Dafang  XIN Ruiqiang 

DOI:10.12015/issn.1674-8034.2026.07.012.


[Abstract] Objective To investigate the value of combined T1-weighted and T2-weighted magnetic resonance black-blood thrombus imaging (BTI) for staging diagnosis of lower extremity deep vein thrombosis (DVT).Materials and Methods A total of 55 patients with first-diagnosed DVT underwent T1-BTI and T2-BTI scanning of the lower extremity deep veins and were divided into acute (n = 29), subacute (n = 13), and chronic (n = 13) stages based on comprehensive clinical diagnosis. On T1-BTI and T2-BTI images, the signal intensity ratio (SIR) at the proximal and distal ends of the thrombus (proximal T1-SIR, proximal T2-SIR, distal T1-SIR, distal T2-SIR, denoted as pT1-SIR, pT2-SIR, dT1-SIR, dT2-SIR, respectively), lumen area ratio, and soft tissue edema score (0 to 3) were measured. Differences in each indicator between acute and subacute stages, as well as between acute and chronic stages, and the diagnostic performance of individual and combined indicators in the above differential scenarios were compared.Results In differentiating acute from subacute DVT, acute-stage pT1-SIR, pT2-SIR, dT1-SIR, and dT2-SIR were all lower than those in subacute stage (all P < 0.05); soft tissue edema score was higher in acute stage (P = 0.037); there was no significant difference in lumen area ratio between groups (P = 0.591). Among single indicators, pT1-SIR had the highest area under the curve (AUC) of 0.944 [95% confidence interval (CI): 0.871 to 1.000], with a sensitivity of 89.7% and specificity of 92.3% for diagnosing acute stage using a cutoff value of ≤1.23. The AUC of pT1-SIR combined with soft tissue edema score was 0.968 (95% CI: 0.911 to 1.000), with a sensitivity of 93.1% and specificity of 100%; the AUC of pT1-SIR combined with dT2-SIR was 0.963 (95% CI: 0.912 to 1.000), with a sensitivity of 86.2% and specificity of 100%. There were no statistically significant differences in AUC between either combined model and single pT1-SIR (both P > 0.05). In differentiating acute from chronic DVT, there were no statistically significant differences in SIR indicators between groups (P > 0.05). Lumen area ratio and soft tissue edema score in acute DVT were significantly higher than those in chronic DVT (P < 0.001). The AUC of soft tissue edema score was 0.996 (95% CI: 0.984 to 1.000), with a sensitivity of 96.6% and specificity of 100% for diagnosing acute stage using a cutoff value of ≥ 1.5; the AUC of lumen area ratio was 0.862 (95% CI: 0.723 to 1.000).Conclusions Combined T1-BTI and T2-BTI can reflect the course of DVT from the two dimensions of thrombus signal and soft tissue edema. Soft tissue edema score has high diagnostic efficacy in ruling out chronic DVT; pT1-SIR is helpful in differentiating acute from subacute DVT, and combined assessment shows good diagnostic performance, but the incremental value compared with single pT1-SIR needs further validation in large-sample studies.
[Keywords] deep vein thrombosis；magnetic resonance imaging；black-blood thrombus imaging；thrombus staging；soft tissue edema

ZHANG Ling1   PENG Ruchen1   WANG Peng1   LI Yancui1   LIU Dafang2   XIN Ruiqiang1*  

1 Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China

2 Department of Vascular Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China

Corresponding author: XIN R Q, E-mail: rxin@ccmu.edu.cn

Conflicts of interest   None.

Received  2026-05-06
Accepted  2026-06-20
DOI: 10.12015/issn.1674-8034.2026.07.012
DOI:10.12015/issn.1674-8034.2026.07.012.

[1]
ZHANG S Y, SHI C, WANG X, et al. Comparison of clinical outcomes among patients with proximal versus isolated distal deep vein thrombosis: a systematic review and meta-analysis[J/OL]. J Vasc Surg Venous Lymphatic Disord, 2025, 13(6): 102281 [2026-04-28]. https://www.ipubmed.cn/Archive/Detail/40545195. DOI: 10.1016/j.jvsv.2025.102281.
[2]
Chinese Society of Microcirculation and Professional Committee of Vascular Disease, Venous Disease and Endovascular Therapy Group. Expert consensus on endovascular treatment of acute lower extremity deep venous thrombosis[J]. J Vasc Endovasc Surg, 2023, 9(5):513-519. DOI: 10.19418/j.cnki.issn2096-0646.2023.05.01.
[3]
SINGH S, KUMAR P, YADAV S K, et al. Recent pathophysiological insights are advancing the treatment of venous thromboembolism[J]. JACC Basic Transl Sci, 2025, 10(5): 689-703. DOI: 10.1016/j.jacbts.2024.12.004.
[4]
ABRAMOWITZ S D, KADO H, SCHOR J, et al. Six-month deep vein thrombosis outcomes by chronicity: analysis of the real-world ClotTriever outcomes registry[J]. J Vasc Interv Radiol, 2023, 34(5): 879-887.e4. DOI: 10.1016/j.jvir.2022.12.480.
[5]
SCHLAGER O, CAMPELLO E, MADARIC J, et al. 2025 ESVM Guidelines on interventional treatment of venous thromboembolism[J]. Vasa, 2025, 54(6): 365-381. DOI: 10.1024/0301-1526/a001211.
[6]
HTUN T, AMRUTIYA R, WIN K H H. Post-thrombotic syndrome: pathophysiology, clinical implications, and advances in management[J/OL]. Health Sci Rep, 2025, 8(12): e71656[2026-05-02]. https://www.ipubmed.cn/Archive/Detail/41424668. DOI: 10.1002/hsr2.71656.
[7]
LI X Q, PAN J, SANG H F. Treatment strategies for subacute lower extremities deep vein thrombosis[J]. J Surg Concepts Pract, 2024, 29(6): 477-480. DOI: 10.16139/j.1007-9610.2024.06.03.
[8]
Venous Disease and Endovascular Therapy Group of Chinese Society of Microcirculation & Professional Committee of Vascular Disease. Expert consensus on endovascular treatment for deep venous post-thrombotic syndrome of lower extremity[J]. J Vasc Endovasc Surg, 2023, 9(7): 769-776, 787. DOI: 10.19418/j.cnki.issn2096-0646.2023.07.01.
[9]
PATEL K D, AHMAD M, TAN M, et al. A systematic review evaluating imaging techniques to determine chronicity of deep vein thrombosis[J]. Phlebology, 2026, 41(3): 179-189. DOI: 10.1177/02683555251358915.
[10]
SANTINI P, ESPOSTO G, AINORA M E, et al. Ultrasound elastography to assess age of deep vein thrombosis: a systematic review[J/OL]. Diagnostics, 2023, 13(12): 2075 [2026-06-11]. https://www.ipubmed.cn/Archive/Detail/37370970. DOI: 10.3390/diagnostics13122075.
[11]
WANG X Y, SUN C R, LIU Y H, et al. Association between thrombus signal intensity and pulmonary embolism in patients with proximal deep vein thrombosis: a magnetic resonance imaging study[J]. Arterioscler Thromb Vasc Biol, 2025, 45(10): 1957-1968. DOI: 10.1161/ATVBAHA.125.322857.
[12]
XIE G X, CHEN H W, HE X P, et al. Black-blood thrombus imaging (BTI): a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis[J/OL]. J Cardiovasc Magn Reson, 2016, 19(1): 4 [2026-01-15]. https://www.ipubmed.cn/Archive/Detail/28095878. DOI: 10.1186/s12968-016-0320-8.
[13]
LI H, HOU M J, JIAO Y J, et al. Diagnostic value of MR black-blood thrombus imaging, contrast-enhanced MRI, and noncontrast-enhanced MR venography in cerebral vein thrombosis: a systematic review and meta-analysis[J]. Eur Radiol, 2026, 36(3): 1758-1770. DOI: 10.1007/s00330-025-11965-8.
[14]
MAO H, GUAN X H, PENG K W, et al. Time-efficient and contrast-free magnetic resonance imaging approach to the diagnosis of deep vein thrombosis on black-blood gradient-echo sequence: a pilot study[J]. Quant Imaging Med Surg, 2021, 11(1): 276-289. DOI: 10.21037/qims-19-761.
[15]
HUANG C, HE X P, XIE Y Y, et al. Thrombus signal on T1-weighted black-blood MR predicts outcomes of catheter-directed thrombolysis in acute deep vein thrombosis[J]. Thromb Haemost, 2023, 123(4): 453-463. DOI: 10.1055/s-0043-1760846.
[16]
WU G, LIU L J, WANG T, et al. T1 mapping is useful for staging deep venous thrombosis in the lower extremities[J]. Acta Radiol, 2022, 63(4): 489-496. DOI: 10.1177/02841851211004425.
[17]
YANG X X, WU F, LIU Y H, et al. Diagnostic performance of MR black-blood thrombus imaging for cerebral venous thrombosis in real-world clinical practice[J]. Eur Radiol, 2022, 32(3): 2041-2049. DOI: 10.1007/s00330-021-08286-x.
[18]
Interventional Physicians Branch of Chinese Medical Doctor Association, Intervention Professional Committee of Chinese Medical Association Radiology Branch, Chinese Intravenous Intervention Union. Expert consensus on the standard of interventional therapy for lower extremity deep venous thrombosis (second edition)[J]. Chin J Interv Radiol Electron Ed, 2018, 6(4): 283-288. DOI: 10.3877/cma.j.issn.2095-5782.2018.04.001.
[19]
Vascular Surgery Group, Society of Surgery, Chinese Medical Association. Guidelines for diagnosis and treatment of deep venous thrombosis (third edition)[J]. Chin J Gen Surg, 2017, 32(9): 807-812. DOI: 10.3760/cma.j.issn.1007-631X.2017.09.032.
[20]
ZHANG L, PENG R C, ZHANG J, et al. Two modulated flip angle techniques in refocused imaging with extended echo train for diagnosing lower extremity deep vein thrombosis[J]. Chin J Med Imaging, 2020, 28(10): 792-797. DOI: 10.3969/j.issn.1005-5185.2020.10.018.
[21]
PENG R C, DU X Y. Application of T2-matrix sequence in the diagnosis of acute lower extremity deep vein thrombosis[J]. Chin J Magn Reson Imaging, 2019, 10(4): 249-253. DOI: 10.12015/issn.1674-8034.2019.04.002.
[22]
ZHONG J L, PENG R C, YANG X Y, et al. The clinical value of 3D-T1WI modulated flip angle technique in refocused imaging with extended echo train technology in diagnosis of deep venous thrombosis[J]. Chin J Magn Reson Imaging, 2019, 10(5): 366-370. DOI: 10.12015/issn.1674-8034.2019.05.010.
[23]
SAHA P, ANDIA M E, MODARAI B, et al. Magnetic resonance T1 relaxation time of venous thrombus is determined by iron processing and predicts susceptibility to lysis[J]. Circulation, 2013, 128(7): 729-736. DOI: 10.1161/CIRCULATIONAHA.113.001371.
[24]
CHERNYSH I N, MUKHOPADHYAY S, JOHNSON T A, et al. Time-dependent ultrastructural changes during venous thrombogenesis and thrombus resolution[J]. J Thromb Haemost, 2024, 22(6): 1675-1688. DOI: 10.1016/j.jtha.2024.02.020.
[25]
BRADLEY W G. MR appearance of hemorrhage in the brain[J]. Radiology, 1993, 189(1): 15-26. DOI: 10.1148/radiology.189.1.8372185.
[26]
GOMORI J M, GROSSMAN R I, YU-IP C, et al. NMR relaxation times of blood: dependence on field strength, oxidation state, and cell integrity[J]. J Comput Assist Tomogr, 1987, 11(4): 684-690.
[27]
CINES D B, LEBEDEVA T, NAGASWAMI C, et al. Clot contraction: compression of erythrocytes into tightly packed polyhedra and redistribution of platelets and fibrin[J]. Blood, 2014, 123(10): 1596-1603. DOI: 10.1182/blood-2013-08-523860.
[28]
GAO L, CHAHER N, SERRALHA J C, et al. Molecular MRI of collagen enables evaluation of fibrosis and therapeutic response in venous thrombosis[J/OL]. Circ Cardiovasc Imaging, 2026, 19(1): e018784[2026-01-15]. https://pubmed.ncbi.nlm.nih.gov/41368713/. DOI: 10.1161/CIRCIMAGING.125.018784.
[29]
KUROIWA Y, YAMASHITA A, MIYATI T, et al. MR signal change in venous thrombus relates organizing process and thrombolytic response in rabbit[J]. Magn Reson Imaging, 2011, 29(7): 975-984. DOI: 10.1016/j.mri.2011.04.015.
[30]
LI Y X. Study on the clinical value of magnetic resonance imaging of deep vein thrombosis in both lower extremity[D]. Guangzhou: Guangzhou Medical University, 2024. DOI: 10.27043/d.cnki.ggzyc.2024.000380.
[31]
SILICKAS J, SMITH A, ANDIA M E, et al. Multiparametric contrast-free MRI successfully identifies venous thrombus responsive to lytic therapy: from mice to humans[J/OL]. Circ Cardiovasc Imaging, 2025, 18(11): e018175[2026-01-15]. https://pubmed.ncbi.nlm.nih.gov/41178413/. DOI: 10.1161/CIRCIMAGING.125.018175.
[32]
MAGNUS L, SCHWEIN A, CHINNADURAI P, et al. Experimental multiparametric magnetic resonance imaging characterization of iliocaval venous thrombosis pathological changes[J/OL]. J Vasc Surg Venous Lymphat Disord, 2024, 12(4): 101895 [2026-04-17]. https://www.ipubmed.cn/Archive/Detail/38679142. DOI: 10.1016/j.jvsv.2024.101895.
[33]
KARANDE G Y, HEDGIRE S S, SANCHEZ Y, et al. Advanced imaging in acute and chronic deep vein thrombosis[J]. Cardiovasc Diagn Ther, 2016, 6(6): 493-507. DOI: 10.21037/cdt.2016.12.06.
[34]
ARNOLDUSSEN C W K P. Imaging of deep venous pathology[J]. Cardiovasc Intervent Radiol, 2024, 47(12): 1580-1594. DOI: 10.1007/s00270-024-03785-y.
[35]
WAKEFIELD T W, MYERS D D, HENKE P K. Mechanisms of venous thrombosis and resolution[J]. Arterioscler Thromb Vasc Biol, 2008, 28(3): 387-391. DOI: 10.1161/atvbaha.108.162289.
[36]
LEÃO R V, BERNAL E C B A, RODRIGUES M B, et al. Venous thrombosis: a mimic of musculoskeletal injury on MR imaging[J]. Skeletal Radiol, 2023, 52(7): 1263-1276. DOI: 10.1007/s00256-022-04258-4.
[37]
ARNOLDUSSEN C W K P, NOTTEN P, BRANS R, et al. Clinical impact of assessing thrombus age using magnetic resonance venography prior to catheter-directed thrombolysis[J]. Eur Radiol, 2022, 32(7): 4555-4564. DOI: 10.1007/s00330-022-08599-5.
[38]
KURSTJENS R L, DE WOLF M A, VAN LAANEN J H, et al. Hemodynamic significance of collateral blood flow in chronic venous obstruction[J]. Phlebology, 2015, 30(1Suppl): 27-34. DOI: 10.1177/0268355515569433.
[39]
ROBERTS N, DIMAGGIO M, HORROW M M. US of lower extremity deep vein thrombosis: a review[J/OL]. RadioGraphics, 2024, 44(11): e240113[2026-05-03]. https://www.ipubmed.cn/Archive/Detail/39480701. DOI: 10.1148/rg.240113.
[40]
LI X, RUFF C, RAFAILIDIS V, et al. Noninvasive and invasive imaging of lower-extremity acute and chronic venous thrombotic disease[J]. Vasc Med, 2023, 28(6): 592-603. DOI: 10.1177/1358863X231198069.
[41]
LOFFREDO L, MAGGIO E, MAGNA A, et al. Predictors, incidence, and proximal extension rate of distal deep vein thrombosis in internal medicine wards: insights from the AURELIO study[J]. Thromb Haemost, 2026, 126(5): 488-495. DOI: 10.1055/a-2595-5458.

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