Echocardiographic quantitative texture analysis of tissue acoustic properties of fresh versus organized ventricular thrombi

The age of a thrombus can be important clinical information in identifying patients at high risk for embolism, but recognizing the age of thrombi is difficult using only clinical data or a qualitative analysis of two-dimensional echocardiograms. We hypothesize that the quantitative analysis of image texture in two-dimensional echocardiograms would be an accurate method for in vivo differentiation of fresh from old ventricular thrombi. To test this hypothesis, we retrospectively evaluated two-dimensional echocardiographic images of cardiac thrombi detected in patients within the 1st week and at 6 months after an acute myocardial infarction with quantitative texture analysis. Of the quantitative texture measures of the first order, mean gray level, skewness, and kurtosis overlapped between fresh and old thrombi, but uniformity was significantly higher in older thrombi (0.036 +/- 0.008 for fresh vs 0.042 +/- 0.008 for old, P < 0.05). Of the second-order measures, entropy was significantly higher in fresh than in old thrombi (4.36 +/- 0.05 vs 4.58 +/- 0.05, P < 0.05), and angular second moment, correlation, and contrast overlapped. In conclusion, computerized quantitative texture analysis can help to differentiate fresh from old ventricular thrombi: old thrombi are characterized by a decrease in heterogeneity, which can be quantified by this technique