Visualization of post-STEMI myocardial infarction and microvascular obstruction with non-contrast, free-breathing whole- heart iT2prep-IR BOOST
In brief
In 60 STEMI patients, a 7-minute scan detected microvascular obstruction with 100% sensitivity
In this single-center study, the noncontrast, free-breathing scan took an average of 7.2 minutes and detected microvascular obstruction with 100% sensitivity and 87.5% specificity. Its estimates of heart muscle injury and edema closely matched standard contrast-enhanced imaging, and obstruction volume was associated with heart remodeling at one year. Larger studies must confirm performance before it can replace standard scans.
- Journal
- Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance (Q1)
- Published
- 19 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Xin Liu, Jifang He, Bowen Zhang, Lu Liang, Bin Sun, Boqia Xie, et al.
- PMID
- 42896791
- DOI
- 10.1016/j.jocmr.2026.102814
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (paper of the day, 20 October 2026): Non‑contrast CMR for MI and MVO detection
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.