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. 2024 Jan 3;14(1):476-488.
doi: 10.21037/qims-23-591. Epub 2023 Nov 28.

Cardiac magnetic resonance imaging detection of intramyocardial hemorrhage in patients with ST-elevated myocardial infarction: comparison between susceptibility-weighted imaging and T1/T2 mapping techniques

Jinyang Wen  1 , Jinhan Qiao  1 , Yuanyuan Tang  1 , Yun Zhao  1 , Zhaoxia Yang  1 , Luyun Wang  2 , Xinwei Tao  3 , Xiaoyue Zhou  4 , Liming Xia  1 , Dazhong Tang #  1 , Lu Huang #  1
Affiliations

Cardiac magnetic resonance imaging detection of intramyocardial hemorrhage in patients with ST-elevated myocardial infarction: comparison between susceptibility-weighted imaging and T1/T2 mapping techniques

Jinyang Wen et al. Quant Imaging Med Surg. .

Abstract

Background: Susceptibility-weighted imaging (SWI) and T1/T2 mapping can be used to detect reperfusion intramyocardial hemorrhage (IMH) in ST-segment elevation myocardial infarction (STEMI) patients. However, the sensitivity and accuracy of the SWI and T1/T2 mapping sequences were not systematically compared. The study aimed to evaluate image quality and diagnostic performance of SWI in patients with IMH, compared with T1/T2 mapping.

Methods: A prospective study was conducted on consecutive acute STEMI patients who were recruited from January to July 2022. Within 2-6 days after reperfusion treatment, all patients underwent a 3T cardiac magnetic resonance (CMR) examination, including T2-weighted short-tau inversion recovery (T2W-STIR), T1/T2 mapping, and SWI. A total of 36 patients [age, 56.50±17.25 years; males, 83.33% (30/36)] were enrolled. The relative infarct-remote myocardium signal intensity ratio (SIinfarct-remote) and contrast-to-noise ratio (CNR) were calculated for each patient on T1/T2 mapping and SWI, and the difference between relative signal intensity-to-noise ratio (rSNR) in the IMH (rSNRIMH) was measured for IMH patients on T1/T2 mapping and SWI. SIinfarct-remote, CNR, and rSNRIMH were compared among the three sequences. Receiver operating characteristic (ROC) analyses were used to evaluate the diagnostic performance of three sequences by SIinfarct-remote and visual assessment.

Results: A total of 26 (72.22%) patients had IMH. Quantitatively, the SIinfarct-remote of three sequences had excellent diagnostic performance for detecting IMH [SWI area under the curve (AUC) =1.000, 95% confidence interval (CI): 1.000-1.000 vs. T1 mapping AUC =0.954, 95% CI: 0.885-1.000 vs. T2 mapping AUC =0.985, 95% CI: 0.955-1.000; SWI vs. T1 mapping, P=0.300; SWI vs. T2 mapping, P=0.188; T1 mapping vs. T2 mapping, P=0.302). Qualitatively, three sequences had similar performance on detecting IMH (SWI AUC =0.895, 95% CI: 0.784-1.000; T1 mapping AUC =0.835, 95% CI: 0.711-0.958; and T2 mapping AUC =0.855, 95% CI: 0.735-0.974; SWI vs. T1 mapping, P=0.172; SWI vs. T2 mapping, P=0.317; T1 mapping vs. T2 mapping, P=0.710). The rSNRIMH was highest in T1 mapping, followed by T2 mapping and SWI, but SWI had the highest CNR.

Conclusions: SWI, as well as T1/T2 mapping, is a feasible and accurate approach for clinical diagnosis of IMH with excellent performance.

Keywords: Susceptibility-weighted imaging (SWI); T1 mapping; T2 mapping; cardiac magnetic resonance (CMR); intramyocardial hemorrhage (IMH).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-591/coif). X.T. and X.Z. are current employees of Bayer Healthcare and Siemens Healthineers, respectively. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of study population enrollment. STEMI, ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; CMR, cardiac magnetic resonance; T2W-STIR, T2-weighted short-tau inversion recovery; IMH, intramyocardial hemorrhage.
Figure 2
Figure 2
Several representative cases with SWI images of different quality to detect IMH (red arrows). 1: excellent image quality; 2: minor artifacts outside of the IMH; 3: artifacts in IMH but analysis possible. SWI, susceptibility-weighted imaging; IMH, intramyocardial hemorrhage.
Figure 3
Figure 3
CMR images of a STEMI patient with IMH presentation after receiving PCI therapy. IMH is presented as a hypointense core within a hyperintense area in the T2W-STIR image (A) corresponding to the infarcted area in the LGE images (B). The same hypointense and hyperintense areas are shown in the SWI (C), Magnitude (D), Phase (E), MIP (F), T1 map (G,H), and T2 map (I,J) images with the red or black arrows indicating IMH within myocardial infarction. T2W-STIR, T2-weighted short-tau inversion recovery; LGE, late gadolinium enhancement; SWI, susceptibility-weighted imaging; MIP, maximum intensity projection; CMR, cardiac magnetic resonance; STEMI, ST-segment elevation myocardial infarction; IMH, intramyocardial hemorrhage; PCI, percutaneous coronary intervention.
Figure 4
Figure 4
SI values for the infarcted myocardium and remote myocardium from the three MRI sequences. **, P<0.01; ***, P<0.001. IMH, intramyocardial hemorrhage; SI, signal intensity; ms, milliseconds; SWI, susceptibility-weighted imaging.
Figure 5
Figure 5
The comparison of rSNRIMH and CNR on three MRI sequences. rSNRIMH, relative signal intensity-to-noise ratios within IMH area; IMH, intramyocardial hemorrhage; SWI, susceptibility-weighted imaging; CNR, contrast-to-noise ratio; MRI, magnetic resonance imaging.
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