An initial clinical evaluation of quantitative susceptibility mapping for quantitative characterization of intramyocardial hemorrhage
Abstract
Objective To characterise the performance of quantitative susceptibility mapping (QSM) for the detection of hemorrhagic iron in the context of ST elevation myocardial infarction (STEMI). Background Iron deposition following intramyocardial hemorrhage in STEMI has a mechanistic role in adverse left ventricular remodelling. Current MRI-based methods for measuring myocardial iron in STEMI, including T 2 *, T 1 , and T 2 mapping, are limited. Iron-mediated T 1 , T 2 , and T 2 * relaxation time shortening is opposed by edema-mediated prolongation of relaxation times, hindering the accuracy of these techniques. In contrast, QSM measures intrinsic tissue magnetic susceptibility, potentially resulting in higher specificity for iron detection in the setting of infarct-related myocardial edema. Methods In this work, 22 patients with STEMI were scanned using QSM and T 2 * mapping sequences. Presence/absence of iron, image quality, and diagnostic confidence was assessed by two expert readers for QSM, T 2 * mapping, and T 2 * weighted imaging (longest echo-time T 2 * map source image). The volume of intramyocardial hemorrhage was quantified for each technique and compared to the volume of microvascular obstruction determined by late-gadolinium enhancement imaging. Mass of hemorrhagic iron in each case was determined using QSM and T 2 * maps. Results In the qualitative analysis, QSM had significantly improved diagnostic confidence and image quality compared to both T 2 * maps and T 2 * weighted images. For quantitative analysis the volume of intramyocardial hemorrhage determined by QSM had a significantly stronger correlation vs the reference standard than both T 2 * map and T 2 * weighted imaging. There was a strong correlation between the mass of hemorrhagic iron calculated by T 2 * map and QSM. Conclusion This work demonstrates, in a patient population, the opportunity QSM presents for improving the assessment of hemorrhagic iron in the context of STEMI. Full evaluation in a large clinical trial is now warranted.
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BibTeX
@article{tyler2026initial,
title = {{An initial clinical evaluation of quantitative susceptibility mapping for quantitative characterization of intramyocardial hemorrhage}},
author = {Andrew Tyler and Matthew Li Kam Wa and Simon Littlewood and Li Huang and Filippo Bosio and Amedeo Chiribiri and Giulia Benedetti and Sébastien Roujol and Pier Giorgio Masci},
journal = {Journal of Cardiovascular Magnetic Resonance},
year = {2026},
month = oct,
doi = {10.1016/j.jocmr.2026.102707},
url = {https://hal.science/hal-05795628v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - An initial clinical evaluation of quantitative susceptibility mapping for quantitative characterization of intramyocardial hemorrhage
AU - Andrew Tyler
AU - Matthew Li Kam Wa
AU - Simon Littlewood
AU - Li Huang
AU - Filippo Bosio
AU - Amedeo Chiribiri
AU - Giulia Benedetti
AU - Sébastien Roujol
AU - Pier Giorgio Masci
PY - 2026
DA - 2026/10/12
JO - Journal of Cardiovascular Magnetic Resonance
DO - 10.1016/j.jocmr.2026.102707
UR - https://hal.science/hal-05795628v1
AB - Objective To characterise the performance of quantitative susceptibility mapping (QSM) for the detection of hemorrhagic iron in the context of ST elevation myocardial infarction (STEMI). Background Iron deposition following intramyocardial hemorrhage in STEMI has a mechanistic role in adverse left ventricular remodelling. Current MRI-based methods for measuring myocardial iron in STEMI, including T 2 *, T 1 , and T 2 mapping, are limited. Iron-mediated T 1 , T 2 , and T 2 * relaxation time shortening is opposed by edema-mediated prolongation of relaxation times, hindering the accuracy of these techniques. In contrast, QSM measures intrinsic tissue magnetic susceptibility, potentially resulting in higher specificity for iron detection in the setting of infarct-related myocardial edema. Methods In this work, 22 patients with STEMI were scanned using QSM and T 2 * mapping sequences. Presence/absence of iron, image quality, and diagnostic confidence was assessed by two expert readers for QSM, T 2 * mapping, and T 2 * weighted imaging (longest echo-time T 2 * map source image). The volume of intramyocardial hemorrhage was quantified for each technique and compared to the volume of microvascular obstruction determined by late-gadolinium enhancement imaging. Mass of hemorrhagic iron in each case was determined using QSM and T 2 * maps. Results In the qualitative analysis, QSM had significantly improved diagnostic confidence and image quality compared to both T 2 * maps and T 2 * weighted images. For quantitative analysis the volume of intramyocardial hemorrhage determined by QSM had a significantly stronger correlation vs the reference standard than both T 2 * map and T 2 * weighted imaging. There was a strong correlation between the mass of hemorrhagic iron calculated by T 2 * map and QSM. Conclusion This work demonstrates, in a patient population, the opportunity QSM presents for improving the assessment of hemorrhagic iron in the context of STEMI. Full evaluation in a large clinical trial is now warranted.
SN - 1097-6647
SN - 1532-429X
ER -