Diagnosing Intramyocardial Hemorrhage using Free-Breathing, Cardiac QSM with Full LV Coverage: Clinical Findings with Validations in Canines

Motivation: Accurate detection and quantification of intramyocardial hemorrhage (IMH) in reperfused myocardial infarction (MI) is crucial for patient management. Goal(s): However, current standard IMH imaging techniques (e.g., breath-hold T2* or 3D R2* maps) pose multiple technical challenges with imaging artifacts and confounders. Approach: This study presents a free-breathing cardiac high-dynamic-range quantitative susceptibility mapping (HDR-QSM) technique to improve IMH detection and quantification over conventional iron-sensitive MRI. Results: Proposed method is tested in animal models and MI patients, which show that HDR-QSM can significantly reduce imaging artifacts, improve accuracy in detection of hMI and quantification of iron quantification within hMI compared to existing standards. Impact: The free-breathing HDR-QSM technique enhances IMH detection and quantification over R2* mapping. It is validated in animals and tested in STEMI patients with impaired breath-holding ability and shows promise for broader clinical use, pending further validation in larger trials.