Abstract

ObjectivesT2*-weighted (T2*w) is deemed as a reference standard for post-infarction intramyocardial haemorrhage (IMH). However, high proportion of T2* images is affected by off-resonance artefacts hampering image interpretation. Diagnostic accuracy and precision of alternative techniques for IMH diagnosis and quantification have been seldomly investigated.Methods and resultsBetween April 2016 and May 2017, 50 ST-segment elevation myocardial infarction patients (66% male, 57 ± 17 years) and 15 healthy controls (60% male, 58 ± 13) were consecutively enrolled. Subjects underwent head-to-head comparison of single mid-infarct slice acquired on black-blood T2-weighted short-TI-inversion recovery (T2w-STIR), bright-blood T2prep-steady-state-free precession (T2prep-SSFP), and T2/T1 maps for IMH diagnosis and quantification against T2*w. All images were graded for quality (grade 1: very poor; grade 4: excellent) and diagnostic confidence (Likert scale, 1: very unsure and 5: highly confident). Reduced relaxation time/hypointense region (hypocore) embedded in infarct-related oedema on T2 map, T1 map, and T2w-STIR had the best overall diagnostic accuracy (per-subject: 91%, 86%, and 86%, respectively; per segment: 95%, 93%, and 93%, respectively). By mixed-effects analysis, image quality, and diagnostic confidence were higher for T2 map and T1 maps than T2*w (p < 0.05 for both scores). For IMH quantification, hypocore on T2 map and T1 map strongly correlated (Spearman’s r > 0.7, p < 0.001 for both) with IMH extent on T2*w and presented an overall excellent agreement on Bland-Altman analysis. By linear mixed model analysis, absolute hypocore size did not differ among T1-, T2 map, and T2*w. T2/T1 maps had the best intra- and inter-observer reproducibility among CMR techniques.ConclusionHypocore on T2/T1 map is the best alternative technique to T2*w for diagnosing and quantifying IMH in post-STEMI patients.Key Point• Mapping techniques are the best alternatives for diagnosing post-infarction intramyocardial haemorrhage.• Mapping techniques are valuable tools for imaging intramyocardial haemorrhage.

Highlights

  • Cardiovascular magnetic resonance (CMR) represents a valuable non-invasive modality for studying the ischemia/reperfusion (I/R) myocardial injury in patients with ST-segment elevation myocardial infarction (STEMI) [1]

  • Intramyocardial haemorrhage (IMH) is a marker of severe I/R damage being associated with microvessel wall destruction and interstitial erythrocyte extravasation [2]

  • We studied a cohort of STEMI patients and healthy control using T2w-short-TI-inversion recovery (STIR) and T2prepSSFP as well as T2/T1 mapping (T1 map) and multi-echo T2*w imaging

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Summary

Introduction

Cardiovascular magnetic resonance (CMR) represents a valuable non-invasive modality for studying the ischemia/reperfusion (I/R) myocardial injury in patients with ST-segment elevation myocardial infarction (STEMI) [1]. Multi-echo T2*w imaging does not allow for the concomitant detection and quantification of infarct-related oedema, which provides relevant complementary information in STEMI [20]. With respect to IMH identification and quantification, these studies were limited by the lack of a properly defined reference standard, spectrum bias due to the absence of a healthy control group and the absence of a direct comparison among the diverse techniques. They seldomly reported the precision of the techniques for IMH quantification, essential information for sample size calculation when planning randomised controlled trials

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