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Updated: Jun 3, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
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.
Insights
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.
Background:
Hemorrhagic myocardial infarction (hMI) can rapidly diminish the benefits of reperfusion therapy and direct the heart toward chronic heart failure. T2∗ cardiac magnetic resonance (CMR) is the reference standard for detecting hMI. However, the lack of clarity around the earliest time point for detection, time-dependent changes in hemorrhage volume, and the optimal methods for detection can limit the development of strategies to manage hMI.
Objectives:
The authors investigated CMR signal characteristics of hMI through time-lapse multiparametric mapping using a clinically relevant animal model and evaluated the translatability in ST-segment elevation MI patients when possible.
Methods:
Canines (N = 20) underwent 3.0-T CMR at baseline and various time points over the first week of reperfused MI. Time-dependent relationships between T1, T2, and T2∗ mapping of hMI, non-hMI, and remote territories were determined. Reperfused ST-segment elevation MI patients (N = 50) were studied to establish clinically feasibility.
Results:
Although hMI was evident <1 hour after reperfusion on histopathology, it was not reliably detected with T1, T2, or T2∗ CMR. However, 24 hours to 7 days postreperfusion, hMI was detectable on T2∗ (27.0 ± 2.4 ms [baseline] vs 11.7 ± 2.8 ms [hMI]; P < 0.001), with stable volume and transmurality. In T2 maps, hMI was most visible 5 to 7 days postreperfusion with an area under the curve of 0.98 (sensitivity and specificity ≥0.95) relative to T2∗. However, this was not the case with T1 (sensitivity <0.8, across all time points).
Conclusions:
HMI cannot be reliably detected with T1, T2, or T2∗ on 3.0-T CMR immediately after reperfusion. However, T2∗ CMR can be used to diagnose hMI between 24 hours and 7 days postreperfusion. T2 maps at 3.0-T are a strong alternative to T2∗ maps for diagnosing hMI, provided CMR is performed 5 to 7 days postreperfusion. However, diagnosing hMI with T1 is significantly more challenging at 3.0-T compared with both T2∗ and T2.
