CMR T1 and T2 mapping and extracellular volume quantification in systolic phase produces superior image quality with less motion artifacts and equal mapping values compared to conventional diastolic mapping

AIM: This study investigated whether systolic phase imaging improves cardiac magnetic resonance (CMR) mapping by reducing artifacts compared with diastolic phase analyses. We evaluated T1 and T2 relaxation times and extracellular volume (ECV) in healthy individuals, early rheumatoid arthritis (ERA), and aortic stenosis (AS) patients. MATERIALS AND METHODS: A total of 114 participants (54 healthy adults, 30 ERA and 30 AS patients) underwent 1.5 T CMR with T1, T2, and ECV mapping in both diastolic and systolic phases. Imaging artifacts were categorized as minor or major, and inter-observer agreement was assessed for image quality and reproducibility. RESULTS: Systolic phase mapping significantly reduced minor imaging artifacts across all cohorts (14% vs 5%, p < 0.001 for T1; 5% vs 2%, p < 0.001 for T2 in healthy cohort), particularly in participants with thinner myocardium. Inter-observer agreement assessed in the ERA cohort was excellent, with higher intraclass correlation coefficients (ICC) for systolic than diastolic mapping, particularly for T2 (0.975 vs 0.867) and ECV (0.951 vs 0.891). Systolic mapping yielded comparable T1 and T2 relaxation times across all cohorts. CONCLUSIONS: Systolic mapping provides comparable T1, T2, and ECV values to diastolic mapping, while reducing artifacts, supporting its clinical applicability across diverse patient profiles.