Performance of 3-T Nonenhanced Whole-Heart bSSFP Coronary MR Angiography: A Comparison with 3-T Modified Dixon Water-Fat Separation Sequence

Purpose To compare the performance of improved nonenhanced whole-heart balanced steady-state free precession (bSSFP) coronary MR angiography (CMRA) with that of the modified Dixon (mDixon) water-fat separation method at 3-T imaging. Materials and Methods From September 2023 to December 2023, patients with suspected coronary artery disease who underwent bSSFP and mDixon CMRA after coronary CT angiography (CCTA) were consecutively recruited. The two sequences' acquisition success rates, subjective image quality scores, objective image quality measurements, and diagnostic performance for coronary stenosis with CCTA as the reference standard were analyzed. Results Sixty-two participants completed two CMRA sequences. Data from 49 participants (30 male and 19 female participants; mean age, 62 years ± 10 [SD]) were ultimately analyzed. The acquisition success rates, overall subjective image quality scores, apparent signal-to-noise ratios, and contrast-to-noise ratios of bSSFP and mDixon were significantly different: 93.5% versus 80.6% (<i>P</i> = .021), 5 versus 4 (<i>P</i> < .001), 33.4 ± 10.6 versus 20.7 ± 7.5 (<i>P</i> < .001), and 14.9 ± 6.2 versus 7.0 ± 3.1 (<i>P</i> < .001), respectively. The sensitivity and specificity of bSSFP in predicting stenosis greater than or equal to 50% were 94.7% (95% CI: 71.9, 99.7) and 96.7% (95% CI: 80.9, 99.8) per participant, 95.8% (95% CI: 76.9, 99.8) and 96.7% (95% CI: 91.3, 98.9) per vessel, and 96.6% (95% CI: 80.4, 99.8) and 99.0% (95% CI: 97.3, 99.7) per segment, respectively. Conclusion Compared with the mDixon water-fat separation method, the improved nonenhanced whole-heart bSSFP sequence performed excellently at 3-T imaging. Nonenhanced bSSFP CMRA sequences at 3-T imaging may be recommended for broader clinical applications. <b>Keywords:</b> Coronary Arteries, Imaging Sequences, Comparative Studies, Technology Assessment, Cardiac, MR Angiography, Coronary Angiography, MRI, Image Quality Enhancement <i>Supplemental material is available for this article.</i> © RSNA, 2025.