Abstract
Cardiovascular disease is the leading global cause of death, underscoring the need for accurate assessment of myocardial injury. The current gold standard, bright-blood late gadolinium enhanced MRI, suffers from poor contrast at the blood-scar interface, reducing sensitivity for subendocardial scar detection and limiting reproducibility. Moreover, reliance on expert manual analysis makes interpretation labor-intensive and variable. Here, we present SPOT, a multi-spectral bright- and black-blood imaging sequence that provides unprecedented scar-to-blood contrast and clear anatomical detail. Integrated with an artificial intelligence (AI) framework for automated image analysis, SPOT enables rapid, fully automated, and operator-independent quantification of myocardial injury. Validated in simulations, animal infarct models, and patients with heart disease, this combined imaging-AI platform delivers accurate detection and quantification in a single acquisition. This innovation presents significant opportunities for earlier diagnosis and enhanced therapeutic management of ischemic heart disease, with potential applications in a wide spectrum of other clinical settings.