Comparison of free breathing 3D mDIXON with single breath-hold 3D inversion recovery sequences for the assessment of Late Gadolinium Enhancement.

PURPOSE: To evaluate the technical and diagnostic performance of three dimensional (3D) mDIXON versus 3D inversion recovery (3D VIAB) and 3D spectral presaturation with inversion recovery (3D SPIR) late gadolinium enhancement (LGE) sequences. METHODS: A total of 78 patients (50 males and 28 females, age 49 ± 18 years) with 1.5 T CMR examination including three different 3D LGE sequences (3D mDIXON, 3D VIAB, and 3D SPIR) were evaluated for technical and diagnostic performance by two readers. Qualitative scores and quantitative signal and contrast-to-noise ratios were compared among sequences. Qualitative comparisons were made using Friedman and Wilcoxon signed rank tests. Quantitative comparisons were made using one way ANOVA. Reader agreements were tested using Cohen's Kappa. Any p-value <0.05 was significant. RESULTS: 19 out of 78 patients (24 %) were excluded due to poor (grade 4) image quality and 29 patients were excluded due to absence of LGE. For the remaining 30 patients, free breathing 3D mDIXON showed higher confidence in diagnosis of subepicardial LGE (p-value < 0.05). 3D mDIXON outperformed 3D SPIR in both visualization of LGE (p = 0.02) and quality of fat suppression (p = 0.001). Nevertheless, 3D mDIXON showed lower image quality compared to the other two sequences. CONCLUSION: Free breathing 3D mDIXON is a diagnostic problem-solving tool, especially when making a diagnosis of subepicardial enhancement and/or fat suppression is needed, owing to its high spatial resolution and robust fat suppression. Choice of 3D LGE sequence should be based on patient's breath-hold ability, diagnostic needs, and institutional availability considering the strengths and limitations of each sequence.