An initial clinical evaluation of quantitative susceptibility mapping for quantitative characterization of intramyocardial hemorrhage

Andrew Tyler; Matthew E Li Kam Wa; Simon J Littlewood; Li Huang; Filippo Bosio; Amedeo Chiribiri; Giulia Benedetti; Sébastien Roujol; Pier Giorgio Masci

doi:10.1016/j.jocmr.2026.102707

An initial clinical evaluation of quantitative susceptibility mapping for quantitative characterization of intramyocardial hemorrhage

J Cardiovasc Magn Reson. 2026 Mar 3;28(1):102707. doi: 10.1016/j.jocmr.2026.102707. Online ahead of print.

Authors

Andrew Tyler¹, Matthew E Li Kam Wa², Simon J Littlewood³, Li Huang⁴, Filippo Bosio³, Amedeo Chiribiri³, Giulia Benedetti⁵, Sébastien Roujol³, Pier Giorgio Masci³

Affiliations

¹ School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Division of Psychology Communication and Human Neuroscience, University of Manchester, Dover St. Building, Dover Street, Manchester, United Kingdom. Electronic address: andrew.tyler@manchester.ac.uk.
² School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, St Thomas' Hospital, London, United Kingdom.
³ School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom.
⁴ Neoscan Solutions GmbH, Magdeburg, Germany.
⁵ School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom; Radiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.

PMID: 41786040
DOI: 10.1016/j.jocmr.2026.102707

Abstract

Background: Iron deposition following intramyocardial hemorrhage in ST elevation myocardial infarction (STEMI) has a mechanistic role in adverse left ventricular remodeling. Current cardiovascular magnetic resonance imaging-based methods for measuring myocardial iron in STEMI, including T₂*, T₁, and T₂ mapping, are limited. Iron-mediated T₁, T₂, and T₂* relaxation time shortening is opposed by edema-mediated prolongation of relaxation times, hindering the accuracy of these techniques. In contrast, quantitative susceptibility mapping (QSM) measures intrinsic tissue magnetic susceptibility, potentially resulting in higher specificity for iron detection in the setting of infarct-related myocardial edema. The objective of this work is to characterize the performance of QSM for the detection of hemorrhagic iron in the context of STEMI.

Methods: 22 patients with STEMI were scanned using QSM and T₂* mapping sequences. Presence/absence of iron, image quality, and diagnostic confidence were assessed by two expert readers for QSM, T₂* mapping, and T₂* weighted imaging (longest echo-time T₂* 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 T₂* maps.

Results: In the qualitative analysis, QSM had significantly improved diagnostic confidence and image quality compared to both T₂* maps and T₂* weighted images. For quantitative analysis, the volume of intramyocardial hemorrhage determined by QSM had a significantly stronger correlation vs the reference standard than both T₂* map and T₂* weighted imaging. There was a strong correlation between the mass of hemorrhagic iron calculated by T₂* 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.

Keywords: IMH; Iron; QSM; Reperfusion injury; STEMI.