Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2026
Visualization of post-STEMI myocardial infarction and microvascular obstruction with non-contrast, free-breathing whole- heart iT2prep-IR BOOST.
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Liu Xin, He Jifang, Zhang Bowen, Liang Lu, Bin Sun, Xie Boqia, Jia Xiuqin, Guo Xiaojuan, An Jing, Zhang Chen, Botnar René M, Prieto Claudia, Kunze Karl P, Dharmakumar Rohan, Yang Hsin-Jung, Yang Qi
Аннотация
BACKGROUND: Clinical adoption of cardiovascular magnetic resonance (CMR) for risk stratification in ST-elevation myocardial infarction (STEMI) is often limited by long scan times and the requirement for breath-holding and contrast agents.
OBJECTIVES: This study aimed to validate a non-contrast, free-breathing 3D whole-heart T1/T2 CMR method (iT2prep-IR BOOST) for rapid assessment of myocardial injury in STEMI patients, hypothesizing that this technique provides promising diagnostic accuracy and quantitative assessment to conventional contrast-enhanced CMR.
METHODS: A free-breathing 3D isotropic whole-heart iT2prep-IR BOOST sequence was performed with a scan time of <8minutes. Sixty-four STEMI patients underwent CMR, including iT2prep-IR BOOST, clinical T2-STIR, late gadolinium enhancement (LGE) and T1/T2 mapping. The diagnostic performance of iT2prep-IR BOOST was evaluated against LGE and T2-STIR to assess myocardial infarction (MI), microvascular obstruction (MVO), and edema. Subgroup analyses further investigated the association between MVO detected by iT2prep-IR BOOST and left ventricular (LV) remodeling at 1-year follow-up.
RESULTS: In 60 STEMI patients, the acquisition was completed in 7.2 ± 0.6min as a single free-breathing 3D whole-heart scan. Patient-level analysis showed high sensitivity and specificity for MVO (100.0% / 87.5%) and segmental MVO detection (95.8% / 97.8%). T2prep-IR BOOST yielded robust image contrast for MI comparable to LGE, while offering comparable edema visualization to T2-STIR. Volumetric and transmurality quantifications of MVO, MI, and edema showed excellent agreement with reference standards (all r > 0.90, p < 0.001), supported by significant biophysical correlations with native T1/T2 values (p < 0.001). Furthermore, in a 1-year follow-up cohort (n=51), baseline T2prep-IR BOOST-derived MVO volume was associated with adverse left ventricular remodeling, showing significant correlations with both ΔLVEDVI (r = 0.305, p = 0.029) and ΔLVESVI (r = 0.293, p = 0.037).
CONCLUSIONS: In this preliminary single-center study, iT2prep-IR BOOST showed promising diagnostic performance and close quantitative agreement with conventional LGE and T2-STIR in stable STEMI patients. Further prospective validation in larger, independent, and more heterogeneous cohorts, including patients unable to undergo contrast-enhanced CMR, is required before this technique can be considered an alternative to standard LGE and T2-weighted sequences.
OBJECTIVES: This study aimed to validate a non-contrast, free-breathing 3D whole-heart T1/T2 CMR method (iT2prep-IR BOOST) for rapid assessment of myocardial injury in STEMI patients, hypothesizing that this technique provides promising diagnostic accuracy and quantitative assessment to conventional contrast-enhanced CMR.
METHODS: A free-breathing 3D isotropic whole-heart iT2prep-IR BOOST sequence was performed with a scan time of <8minutes. Sixty-four STEMI patients underwent CMR, including iT2prep-IR BOOST, clinical T2-STIR, late gadolinium enhancement (LGE) and T1/T2 mapping. The diagnostic performance of iT2prep-IR BOOST was evaluated against LGE and T2-STIR to assess myocardial infarction (MI), microvascular obstruction (MVO), and edema. Subgroup analyses further investigated the association between MVO detected by iT2prep-IR BOOST and left ventricular (LV) remodeling at 1-year follow-up.
RESULTS: In 60 STEMI patients, the acquisition was completed in 7.2 ± 0.6min as a single free-breathing 3D whole-heart scan. Patient-level analysis showed high sensitivity and specificity for MVO (100.0% / 87.5%) and segmental MVO detection (95.8% / 97.8%). T2prep-IR BOOST yielded robust image contrast for MI comparable to LGE, while offering comparable edema visualization to T2-STIR. Volumetric and transmurality quantifications of MVO, MI, and edema showed excellent agreement with reference standards (all r > 0.90, p < 0.001), supported by significant biophysical correlations with native T1/T2 values (p < 0.001). Furthermore, in a 1-year follow-up cohort (n=51), baseline T2prep-IR BOOST-derived MVO volume was associated with adverse left ventricular remodeling, showing significant correlations with both ΔLVEDVI (r = 0.305, p = 0.029) and ΔLVESVI (r = 0.293, p = 0.037).
CONCLUSIONS: In this preliminary single-center study, iT2prep-IR BOOST showed promising diagnostic performance and close quantitative agreement with conventional LGE and T2-STIR in stable STEMI patients. Further prospective validation in larger, independent, and more heterogeneous cohorts, including patients unable to undergo contrast-enhanced CMR, is required before this technique can be considered an alternative to standard LGE and T2-weighted sequences.