Rapid Late Gadolinium Enhancement Cardiac MRI in Real-World Clinical Practice: A Prospective Clinical Trial

Purpose To compare two rapid late gadolinium enhancement (LGE) cardiac MRI sequences-phase-sensitive inversion recovery (PSIR) single-shot true fast imaging with steady-state precession (TrueFISP) and motion-corrected TrueFISP PSIR (moco PSIR)-with the PSIR turbo fast low-angle shot (turboFLASH) sequence regarding image quality, localization, and quantification of LGE. Materials and Methods This prospective study included consecutive participants who underwent contrast-enhanced cardiac MRI with three LGE sequences between March 2022 and April 2023. TurboFLASH was the reference standard and was compared with the TrueFISP PSIR and moco PSIR sequences. Primary outcomes were overall image quality scores and contrast-to-noise ratios. Secondary outcomes included qualitative and quantitative assessments of LGE and microvascular obstruction. Statistical analyses included <i>t</i> tests, Wilcoxon signed rank tests, Bland-Altman analysis, and intraclass correlation coefficient. Results A total of 187 participants (mean age, 56.7 years ± 15.1 [SD]; 125 male participants) successfully underwent imaging using all three LGE sequences. All 112 LGE-positive (60%) and 67 LGE-negative (36%) participants undergoing turboFLASH sequencing showed identical results using both TrueFISP and moco PSIR. Overall image quality scores and contrast-to-noise ratios were higher for moco PSIR and TrueFISP than for turboFLASH (<i>P</i> < .001). In participants with ischemic heart disease (<i>n</i> = 94), we found no evidence of difference among the three sequences in LGE-positive layers or segment counts, LGE mass, or microvascular obstruction quantification. Bland-Altman and intraclass correlation coefficient analyses showed a strong agreement across sequences (intraclass correlation coefficient, 0.99). Conclusion Good image quality was achieved with the two rapid sequences in a single breath hold or free-breathing state, in addition to accurate LGE localization and quantification in participants with ischemic heart disease. <b>Keywords:</b> MR-Contrast Agent, Cardiac <i>Supplemental material is available for this article.</i> © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license.