Accurate Intramyocardial Hemorrhage Assessment with Fast, Free-running, Cardiac Quantitative Susceptibility Mapping

Purpose To evaluate the performance of a high-dynamic-range quantitative susceptibility mapping (HDR-QSM) cardiac MRI technique to detect intramyocardial hemorrhage (IMH) and quantify iron content using phantom and canine models. Materials and Methods A free-running whole-heart HDR-QSM technique for IMH assessment was developed and evaluated in calibrated iron phantoms and 14 IMH female canine models. IMH detection and iron content quantification performance of this technique was compared with the conventional iron imaging approaches, R2*(1/T2*) maps, using measurements from ex vivo imaging as the reference standard. Results Phantom studies confirmed HDR-QSM's accurate iron content quantification and artifact mitigation ability by revealing a strong linear relationship between iron concentration and QSM values (<i>R</i>², 0.98). In in vivo studies, HDR-QSM showed significantly improved image quality and susceptibility homogeneity in nonaffected myocardium by alleviating motion and off-resonance artifacts (HDR-QSM vs R2*: coefficient of variation, 0.31 ± 0.16 [SD] vs 0.73 ± 0.36 [<i>P</i> < .001]; image quality score [five-point Likert scale:], 3.58 ± 0.75 vs 2.87 ± 0.51 [<i>P</i> < .001]). Comparison between in vivo susceptibility maps and ex vivo measurements showed higher performance of HDR-QSM compared with R2* mapping for IMH detection (area under the receiver operating characteristic curve, 0.96 vs 0.75; <i>P</i> < .001) and iron content quantification (<i>R</i>², 0.71 vs 0.14). Conclusion In a canine model of IMH, the fast and free-running cardiac QSM technique accurately detected IMH and quantified intramyocardial iron content of the entire heart within 5 minutes without requiring breath holding. <b>Keywords:</b> High-Dynamic-Range Quantitative Susceptibility Mapping, Myocardial Infarction, Intramyocardial Hemorrhage, MRI <i>Supplemental material is available for this article.</i> ©RSNA, 2024.