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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
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Detecting Hemorrhagic Myocardial Infarction With 3.0-T CMR: Insights Into Spatial Manifestation, Time-Dependence,
Yinyin Chen1, Hang Jin1, Xingming Guan2
1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.
JACC. Cardiovascular Imaging
|January 11, 2025
Summary
Hemorrhagic myocardial infarction (hMI) is not reliably detected by cardiac magnetic resonance (CMR) immediately after reperfusion. T2* and T2 mapping can diagnose hMI between 24 hours and 7 days post-reperfusion.
Area of Science:
- Cardiovascular Imaging
- Magnetic Resonance Imaging
- Myocardial Infarction Research
Background:
- Hemorrhagic myocardial infarction (hMI) can negate reperfusion therapy benefits, leading to heart failure.
- T2* cardiac magnetic resonance (CMR) is the gold standard for hMI detection.
- Early detection and optimal imaging methods for hMI remain unclear.
Purpose of the Study:
- To investigate CMR signal characteristics of hMI using time-lapse multiparametric mapping.
- To evaluate the translatability of findings in ST-segment elevation myocardial infarction (STEMI) patients.
- To clarify the earliest detection time points and optimal imaging sequences for hMI.
Main Methods:
- Canine models (N=20) underwent 3.0-T CMR at baseline and over the first week post-reperfusion.
- Time-dependent T1, T2, and T2* mapping of hMI, non-hMI, and remote territories were analyzed.
- Clinical feasibility was assessed in reperfused STEMI patients (N=50).
Main Results:
- hMI was not reliably detected by T1, T2, or T2* CMR within 1 hour post-reperfusion.
- hMI was detectable by T2* CMR between 24 hours and 7 days post-reperfusion (P < 0.001).
- T2 maps showed high diagnostic performance (AUC=0.98) for hMI 5-7 days post-reperfusion, outperforming T1 mapping.
Conclusions:
- Immediate post-reperfusion hMI detection is unreliable with current T1, T2, or T2* CMR sequences.
- T2* CMR is effective for diagnosing hMI between 24 hours and 7 days.
- T2 mapping serves as a viable alternative to T2* for hMI diagnosis 5-7 days post-reperfusion, while T1 mapping is less effective.
