Clinical Feasibility, Efficiency, and Diagnostic Concordance of Full Free-breathing Cardiac MRI Compared with Breath-holding Techniques.

Abstract

Purpose To evaluate the feasibility, efficiency, and diagnostic concordance of a full comprehensive free-breathing cardiac MRI protocol. Materials and Methods In this prospective study conducted between June 2024 and August 2024, free-breathing and breath-holding MRI acquisitions were compared across all sequences using a 3.0-T scanner. Outcomes included scanning time, image quality, left ventricular (LV) functional parameters, and tissue characterization. Paired comparisons between free-breathing and breath-holding acquisitions were performed using matched-pairs Wilcoxon tests or t tests as appropriate. Results In this analysis of 605 participants (mean age ± SD, 48 years ± 17; 422 male), the full free-breathing cardiac MRI protocol reduced scanning duration compared with breath-holding techniques (20.9 minutes ± 3.1 vs 34.4 minutes ± 7.5; P < .001); free-breathing cine, T1 mapping, and late gadolinium enhancement (LGE) acquisitions achieved 54%, 28%, and 33% time reductions, respectively. Free-breathing cardiac MRI consistently achieved diagnostic image quality: Cine had a slightly lower score (4 [IQR, 4-4] vs 5 [IQR, 4-5]; P < .001), whereas T1/T2 mapping and flow showed similar scores of 5 (P > .05). LGE scores were higher with free-breathing (5 [IQR, 5-5] vs 5 [IQR, 4-5]; P < .001). Interobserver agreement was strong (κ = 0.80-0.93). Compared with the breath-holding measurement, free-breathing LV end-diastolic volume and LV end-systolic volume were higher (189.94 mL ± 84.74 vs 192.92 mL ± 86.32, P < .001; 104.99 mL ± 83.14 vs 108.52 mL ± 84.45, P < .001, respectively), whereas LV ejection fraction was lower (50.01% ± 17.93 vs 48.92% ± 17.66, P < .001), with excellent agreement between methods (intraclass correlation coefficient, 0.98-0.99). Native T1 values and LGE mass were slightly higher with free-breathing (P ≤ .001) but remained in excellent agreement with breath-holding methods. Conclusion Full free-breathing cardiac MRI reduced scanning duration while maintaining diagnostic image quality and strong agreement with breath-holding techniques across all sequences. Keywords: Cardiac MRI, Free-breathing, Breath-holding, Cardiac Imaging Supplemental material is available for this article. © RSNA, 2026.