Evaluation of Free-breathing, non-ECG triggered Magnetic Resonance T1 mapping derived from multitasking imaging at 3.0 T in patients with ischemic and non-ischemic cardiomyopathy.

Abstract

Objective: To evaluate the image quality of the free-breathing, non-ECG-Multitasking T1 mapping and to compare T1 values, lesion area and ROC curve with those derived from the traditional MOLLI sequence in ischemic and non-ischemic cardiomyopathy.

Methods: In vitro, T1 values from CMR Multitasking and MOLLI images were compared in 4 phantoms. In vivo studies included 108 patients (38 ischemic cardiomyopathy, 70 non-ischemic cardiomyopathy) and 31 healthy volunteers. All underwent mid-ventricular short-axis CMR Multitasking（free-breathing） and MOLLI (breath-held). Image quality was scored (4-point scale). T1 values and lesion areas were compared via linear regression, Bland-Altman analysis, and ROC curves (LGE as reference).

Results: Phantom T1 values showed excellent agreement (Multitasking v.s. reference: R2 = 0.99, P < 0.001). In vivo, Multitasking strongly correlated with MOLLI for native T1 in healthy subjects (R2 = 0.69), ischemic (R2 = 0.71), and nonischaemic groups (R2 = 0.81, all P < 0.001). Multitasking demonstrated superior image quality in patients with breath-holding difficulties and adverse heart rates P < 0.001). MOLLI image quality declined with breath-holding difficulties, arrhythmia, and high BMI (P < 0.05); Multitasking was less affected but still impacted by BMI (P < 0.05). Lesion areas showed no inter-sequence differences (P > 0.05). ROC analysis revealed comparable diagnostic accuracy between sequences in stable patients (P > 0.05), but superior Multitasking performance in breath-holding difficulties and arrhythmia subgroups (P < 0.05).

Conclusion: Multitasking provides accurate T1 quantification and lesion delineation in cardiomyopathy, with enhanced robustness for patients with poor breath-holding or arrhythmia. BMI-related limitations warrant technical refinement.

Advances in knowledge：: Free-breathing, non-ECG CMR Multitasking achieves accurate T1 mapping in ischaemic/non-ischaemic cardiomyopathy, overcoming ECG/respiratory limitation.