Non-contrast 3.0T coronary magnetic resonance angiography: Image quality comparison of coronal balanced-turbo-field-echo, axial turbo-field-echo, and modified-Dixon sequences

doi:10.4329/wjr.v18.i2.115741

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World Journal of Radiology

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©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.

World J Radiol. Feb 28, 2026; 18(2): 115741
Published online Feb 28, 2026. doi: 10.4329/wjr.v18.i2.115741

Non-contrast 3.0T coronary magnetic resonance angiography: Image quality comparison of coronal balanced-turbo-field-echo, axial turbo-field-echo, and modified-Dixon sequences

Chuang-Wei Wei, Run-Zhi Zhang, Yan Xu, Jia-Yi Liu, Nan Zhang, Lei Xu, Zhao-Ying Wen

Chuang-Wei Wei, Run-Zhi Zhang, Yan Xu, Jia-Yi Liu, Nan Zhang, Lei Xu, Zhao-Ying Wen, Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing 100029, China

Co-first authors: Chuang-Wei Wei and Run-Zhi Zhang.

Co-corresponding authors: Jia-Yi Liu and Nan Zhang.

Author contributions: Wei CW and Zhang RZ jointly undertook the essential first-author responsibilities, including study design, data acquisition, data analysis, and drafting of the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Xu Y contributed to the study design; Liu JY and Zhang N supervised the project and provided overall methodological guidance they contributed equally to this article, they are the co-corresponding authors of this manuscript; Xu L and Wen ZY critically revised the manuscript for important intellectual content; and all authors thoroughly reviewed and endorsed the final manuscript.

Supported by the National Natural Science Foundation of China, No. 82202139.

Institutional review board statement: This study was approved by the Medical Ethics Committee of Beijing Anzhen Hospital, Capital Medical University, approval No. 2025232x.

Clinical trial registration statement: This study is a prospective imaging comparison study and does not involve clinical trial interventions requiring trial registration.

Informed consent statement: Written informed consent was obtained from all participants.

Conflict-of-interest statement: Zhang N reports grants from the National Natural Science Foundation of China during the conduct of the study.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: Data are not publicly available due to participant privacy and institutional restrictions. De-identified data may be made available from the corresponding author upon reasonable request and with approval from the Institutional Review Board.

Corresponding author: Nan Zhang, MD, Chief, Professor, Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, No. 2 Anzhen Road, Chaoyang District, Beijing 100029, China. nzhang_1987@163.com

Received: October 24, 2025
Revised: November 25, 2025
Accepted: January 9, 2026
Published online: February 28, 2026
Processing time: 124 Days and 19 Hours

Abstract

BACKGROUND

Non-contrast whole-heart coronary magnetic resonance angiography (CMRA) remains underutilized in clinical practice due to limited visualization of distal vessels and prolonged acquisition times.

AIM

To evaluate the performance of a coronal balanced turbo field echo (BTFE) sequence for CMRA at 3.0T in comparison with conventional axial turbo field echo (TFE) and modified Dixon (mDixon) sequences.

METHODS

Healthy young volunteers were prospectively enrolled from January 2025 to April 2025. All participants underwent coronary artery imaging using BTFE, TFE, and mDixon sequences. Subjective image quality was assessed based on the society of cardiovascular computed tomography 18-segment model using a four-point scale (1 = non-assessable to 4 = excellent) across the three major coronary arteries and their side branches. The assessability rate was defined as the percentage of segments receiving a score ≥ 2. Objective evaluation of the main coronary arteries included measurements of signal-to-noise ratio, contrast-to-noise ratio, vessel edge sharpness, and visible vessel length. Acquisition time was recorded for each sequence. Statistical comparisons among the three sequences were performed using the Friedman test and one-way repeated measures analysis of variance.

RESULTS

A total of 22 participants (mean age ± SD, 23 ± 2 years; 12 men) were included in the study. BTFE significantly outperformed both TFE and mDixon in subjective image quality scores across all coronary segments (all P < 0.05), except for the left main coronary artery, the proximal and mid segments of the left anterior descending artery (LAD), the proximal and mid segments of the left circumflex artery (LCX), the proximal segment of the right coronary artery, and ramus intermedius, for which no significant differences were observed between BTFE and mDixon (P > 0.05). The BTFE sequence achieved the highest overall assessability (99.3%, 282/284), surpassing mDixon (95.4%, 271/284) and TFE (87.0%, 247/284). BTFE yielded significantly higher signal-to-noise ratio, contrast-to-noise ratio, and vessel edge sharpness compared with both TFE and mDixon (all P < 0.001). The measured lengths of the LAD and right coronary artery were also significantly greater with BTFE (P < 0.05 for both). The LCX length was significantly longer on BTFE than on TFE (77.5 ± 10.5 mm vs 75.1 ± 8.3 mm; P = 0.017), but not significantly different from that on mDixon (77.5 ± 10.5 mm vs 75.7 ± 8.8 mm; P = 0.074). Additionally, BTFE demonstrated a shorter and more consistent acquisition time compared with both TFE and mDixon (6.13 ± 1.00 minutes vs 7.15 ± 2.02 minutes vs 7.17 ± 1.72 minutes; P < 0.05).

CONCLUSION

Coronal BTFE-based non-contrast whole-heart CMRA at 3.0T offers superior image quality and reduced acquisition time compared with conventional axial TFE and mDixon sequences.

Keywords: 3.0T; Magnetic resonance angiography; Coronary artery; Coronary artery disease; Image quality

Core Tip: This study presents a focused technical evaluation of a newly implemented coronal-plane balanced turbo field echo (BTFE) sequence for non-contrast-enhanced coronary magnetic resonance angiography at 3.0T. Through a prospective intra-individual comparison with conventional axial turbo field echo and modified Dixon sequences, the coronal BTFE protocol demonstrated superior image quality - particularly in distal coronary segments - and a shorter acquisition time. These findings indicate that coronal BTFE-based whole-heart coronary magnetic resonance angiography provides a more efficient and diagnostically robust alternative for non-contrast coronary imaging at 3.0T.