title: Susceptibility-weighted cardiovascular magnetic resonance in comparison to T2 and T2 star imaging for detection of intramyocardial hemorrhage following acute myocardial infarction at 3 Tesla.
abstract: BACKGROUND
  Intramyocardial hemorrhage (IMH) identified by cardiovascular magnetic resonance (CMR) is an established prognostic marker following acute myocardial infarction (AMI). Detection of IMH by T2-weighted or T2 star CMR can be limited by long breath hold times and sensitivity to artefacts, especially at 3T. We compared the image quality and diagnostic ability of susceptibility-weighted magnetic resonance imaging (SW MRI) with T2-weighted and T2 star CMR to detect IMH at 3T.
  
  
  METHODS
  Forty-nine patients (42 males; mean age 58 years, range 35-76) underwent 3T cardiovascular magnetic resonance (CMR) 2 days following re-perfused AMI. T2-weighted, T2 star and SW MRI images were obtained. Signal and contrast measurements were compared between the three methods and diagnostic accuracy of SW MRI was assessed against T2w images by 2 independent, blinded observers. Image quality was rated on a 4-point scale from 1 (unusable) to 4 (excellent).
  
  
  RESULTS
  Of 49 patients, IMH was detected in 20 (41%) by SW MRI, 21 (43%) by T2-weighted and 17 (34%) by T2 star imaging (p = ns). Compared to T2-weighted imaging, SW MRI had sensitivity of 93% and specificity of 86%. SW MRI had similar inter-observer reliability to T2-weighted imaging (κ = 0.90 and κ = 0.88 respectively); both had higher reliability than T2 star (κ = 0.53). Breath hold times were shorter for SW MRI (4 seconds vs. 16 seconds) with improved image quality rating (3.8 ± 0.4, 3.3 ± 1.0, 2.8 ± 1.1 respectively; p < 0.01).
  
  
  CONCLUSIONS
  SW MRI is an accurate and reproducible way to detect IMH at 3T. The technique offers considerably shorter breath hold times than T2-weighted and T2 star imaging, and higher image quality scores.
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK. A.Kidambi@leeds.ac.uk.
authors.forename: Ananth
authors.initials: A
authors.lastname: Kidambi
authors.affiliation: Division of Medical Physics & Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. johnbiglands@gmail.com.
authors.forename: John D
authors.initials: JD
authors.lastname: Biglands
authors.affiliation: Philips Healthcare, Philips Centre, Guildford, Surrey, UK. david.higgins@philips.com.
authors.forename: David M
authors.initials: DM
authors.lastname: Higgins
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK. D.Ripley@leeds.ac.uk.
authors.forename: David P
authors.initials: DP
authors.lastname: Ripley
authors.affiliation: Division of Medical Physics & Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. A.Zaman@leeds.ac.uk.
authors.forename: Arshad
authors.initials: A
authors.lastname: Zaman
authors.affiliation: Division of Medical Physics & Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. dab@medphysics.leeds.ac.uk.
authors.forename: David A
authors.initials: DA
authors.lastname: Broadbent
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK. A.K.McDiarmid@leeds.ac.uk.
authors.forename: Adam K
authors.initials: AK
authors.lastname: McDiarmid
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK. P.Swoboda@leeds.ac.uk.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Swoboda
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK. T.A.Musa@leeds.ac.uk.
authors.forename: Tarique
authors.initials: T
authors.lastname: Al Musa
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK. B.Erhayiem@leeds.ac.uk.
authors.forename: Bara
authors.initials: B
authors.lastname: Erhayiem
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK. J.Greenwood@leeds.ac.uk.
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK. S.Plein@leeds.ac.uk.
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA