All-in-One Cardiac MRI: Unified Non–Contrast-enhanced and Contrast-enhanced Imaging for a Continuous-Acquisition Examination

Purpose To evaluate a novel continuous-acquisition cardiac MRI method that integrates non-contrast-enhanced and contrast-enhanced imaging within a single 20-minute, free-breathing, non-electrocardiographically (ECG) gated scan. Materials and Methods A three-dimensional (3D) stack-of-stars T2-prepared fast low angle shot (FLASH) pulse sequence, combined with a 3D multitasking reconstruction and multiparametric mapping framework, was developed to jointly reconstruct coregistered precontrast and postcontrast images. A prospective study conducted from September 2021 to February 2022 involved 10 healthy human volunteers (mean age, 37 years ± 21 [SD]; eight male, two female) and four pigs with reperfusion injury. Quantitative and qualitative MRI measurements were verified in a digital phantom and in vivo. Statistical analysis included intraclass correlation coefficient, Bland-Altman analysis, and paired <i>t</i> tests to compare the proposed method against reference methods. Results Multitasking T1 measurements were highly correlated with two-dimensional (2D) inversion recovery spin-echo-T1 (<i>R²</i> > 0.99) and T2 measurements with 2D spin-echo-T2 (<i>R²</i> > 0.960) in the phantom study. In vivo, multitasking provided higher myocardial T1 values than did modified Look-Locker inversion recovery (MOLLI) (1383 msec ± 37.8 vs 1217 msec ± 16.3; <i>P</i> < .001) and higher myocardial T2 values than did T2-prep FLASH (43.9 msec ± 1.4 vs 40.0 msec ± 1.6; <i>P</i> < .001). There was no evidence of a difference between multitasking and MOLLI extracellular volume (ECV) values (27.5% ± 1.4 and 27.9% ± 1.8; <i>P</i> = .52). In pigs, the proposed method depicted increased precontrast T1 and ECV in ischemic injury regions, aligning well with reference measurements. Conclusion The novel 3D multitasking method enables a comprehensive, 20-minute, push-button cardiac MRI examination without ECG gating or breath holding, providing cardiac function, T1, T2, ECV, and late gadolinium enhancement measurements. <b>Keywords:</b> Cardiac MRI, Cardiac MRI Multitasking, Continuous-Acquisition Cardiac MRI, All-in-One Cardiac MRI <i>Supplemental material is available for this article.</i> © RSNA, 2025.