Non-contrast 3.0T coronary magnetic resonance angiography: Image quality comparison of coronal balanced-turbo-field-echo, axial turbo-field-echo, and modified-Dixon sequences.

Abstract

Background: Non-contrast whole-heart coronary magnetic resonance angiography (CMRA) remains underutilized in clinical practice due to limited visualization of distal vessels and prolonged acquisition times.

Aim: To evaluate the performance of a coronal balanced turbo field echo (BTFE) sequence for CMRA at 3.0T in comparison with conventional axial turbo field echo (TFE) and modified Dixon (mDixon) sequences.

Methods: Healthy young volunteers were prospectively enrolled from January 2025 to April 2025. All participants underwent coronary artery imaging using BTFE, TFE, and mDixon sequences. Subjective image quality was assessed based on the society of cardiovascular computed tomography 18-segment model using a four-point scale (1 = non-assessable to 4 = excellent) across the three major coronary arteries and their side branches. The assessability rate was defined as the percentage of segments receiving a score ≥ 2. Objective evaluation of the main coronary arteries included measurements of signal-to-noise ratio, contrast-to-noise ratio, vessel edge sharpness, and visible vessel length. Acquisition time was recorded for each sequence. Statistical comparisons among the three sequences were performed using the Friedman test and one-way repeated measures analysis of variance.

Results: A total of 22 participants (mean age ± SD, 23 ± 2 years; 12 men) were included in the study. BTFE significantly outperformed both TFE and mDixon in subjective image quality scores across all coronary segments (all P < 0.05), except for the left main coronary artery, the proximal and mid segments of the left anterior descending artery (LAD), the proximal and mid segments of the left circumflex artery (LCX), the proximal segment of the right coronary artery, and ramus intermedius, for which no significant differences were observed between BTFE and mDixon (P > 0.05). The BTFE sequence achieved the highest overall assessability (99.3%, 282/284), surpassing mDixon (95.4%, 271/284) and TFE (87.0%, 247/284). BTFE yielded significantly higher signal-to-noise ratio, contrast-to-noise ratio, and vessel edge sharpness compared with both TFE and mDixon (all P < 0.001). The measured lengths of the LAD and right coronary artery were also significantly greater with BTFE (P < 0.05 for both). The LCX length was significantly longer on BTFE than on TFE (77.5 ± 10.5 mm vs 75.1 ± 8.3 mm; P = 0.017), but not significantly different from that on mDixon (77.5 ± 10.5 mm vs 75.7 ± 8.8 mm; P = 0.074). Additionally, BTFE demonstrated a shorter and more consistent acquisition time compared with both TFE and mDixon (6.13 ± 1.00 minutes vs 7.15 ± 2.02 minutes vs 7.17 ± 1.72 minutes; P < 0.05).

Conclusion: Coronal BTFE-based non-contrast whole-heart CMRA at 3.0T offers superior image quality and reduced acquisition time compared with conventional axial TFE and mDixon sequences.