Human In Vivo Diffusion-Weighted Cardiac Magnetic Resonance in the Detection of Acute Myocardial Infarction: A Systematic Review

Objectives To systematically evaluate the diagnostic performance, technical characteristics, and clinical feasibility of diffusion-weighted imaging (DWI) for the detection of acute myocardial infarction (AMI). Methods A systematic literature search of PubMed, Embase, and Web of Science was performed from inception to March 28, 2026. Studies evaluating DWI in human subjects with AMI were included. Data on study design, patient characteristics, imaging protocols, and diagnostic performance were extracted. Risk of bias was assessed using QUADAS-2. Due to heterogeneity in study design and outcomes, a narrative synthesis was performed. Results Seven studies comprising 184 patients with AMI were included. The pooled mean age was 59.8 ± 12.4 years (n = 177). All studies used 1.5-T MRI systems with ECG-triggered DWI acquisitions. DWI demonstrated high diagnostic sensitivity for AMI detection, ranging from 83% to 96.7%, with specificity between 90% and 100%. Compared with T2-weighted imaging (T2WI), DWI consistently showed superior sensitivity and improved lesion conspicuity, particularly in anatomically challenging regions. Quantitative analyses revealed significant differences in apparent diffusion coefficient (ADC) values between infarcted and remote myocardium across studies. However, substantial heterogeneity in acquisition parameters, including b-values and motion compensation techniques, was observed. Risk of bias was low to moderate overall, with concerns primarily related to patient selection and reporting of index test methodology. Conclusion DWI demonstrates promising diagnostic performance for the detection of AMI and may provide incremental value over conventional T2WI. Despite encouraging results, technical variability and limited standardization currently restrict widespread clinical adoption. Further large-scale, multicenter studies are required to validate these findings.