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

Table 1 Non-contrast coronary magnetic resonance angiography acquisition parameters

Parameter	BTFE	TFE	mDixon
No. slices	250	150	150
Field of view (mm × mm)	280 × 340	265 × 301	265 × 301
Matrix	208 × 234	212 × 201	176 × 201
Repetition time (millisecond)	Shortest	Shortest	Shortest
Echo time (millisecond)	Shortest	Shortest	Shortest
Flip angle (degrees)	70	20	10
Number of signal averages	1	1	1
Fat/blood suppression	Spectral-attenuated inversion recovery	Spectral-attenuated inversion recovery	Water-fat separation
Acquired voxel (mm³)	1.35 × 1.45 × 1.55	1.25 × 1.50 × 1.50	1.50 × 1.50 × 1.50
Reconstructed voxel (mm³)	0.75 × 0.75 × 0.75	0.75 × 0.75 × 0.75	0.75 × 0.75 × 0.75

BTFE: Balanced turbo field echo; TFE: Turbo field echo; mDixon: Modified Dixon.

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Table 2 Participant characteristics and comparison of subjective image quality score at balanced turbo field echo, turbo field echo, and modified Dixon sequences

Characteristic	BTFE	TFE	mDixon	Intergroups P value¹	P value (adjusted P value)²	P value (adjusted P value)³	P value (adjusted P value)⁴
Sex	-	-	-	NA	NA	NA	NA
Male	12	12	12	-	-	-	-
Female	10	10	10	-	-	-	-
Age (year), mean ± SD	23 ± 2	23 ± 2	23 ± 2	NA	NA	NA	NA
HR (beats/minute), mean ± SD	67 ± 7	67 ± 7	67 ± 7	NA	NA	NA	NA
BMI, mean ± SD	21.2 ± 1.4	21.2 ± 1.4	21.2 ± 1.4	NA	NA	NA	NA
Image quality score
LM	4.0 (4.0-4.0)	3.0 (3.0-3.0)	4.0 (4.0-4.0)	< 0.001	< 0.001	0.177	0.009
LAD-pro	4.0 (4.0-4.0)	3.0 (3.0-4.0)	4.0 (4.0-4.0)	< 0.001	< 0.001	0.306	0.003
LCX-pro	4.0 (4.0-4.0)	3.0 (3.0-3.25)	4.0 (4.0-4.0)	< 0.001	< 0.001	0.583	< 0.001
RCA-pro	4.0 (4.0-4.0)	3.0 (3.0-3.25)	4.0 (4.0-4.0)	< 0.001	< 0.001	0.084	< 0.001
LAD-mid	4.0 (4.0-4.0)	3.0 (2.75-3.0)	4.0 (3.875-4.0)	< 0.001	< 0.001	0.489	< 0.001
RCA-mid	4.0 (4.0-4.0)	3.0 (2.5-3.0)	3.75 (2.875-4.0)	< 0.001	< 0.001	0.024	< 0.001
LAD-dis	4.0 (3.875-4.0)	3.0 (2.0-3.0)	3.0 (3.0-4.0)	< 0.001	< 0.001	< 0.001	0.009
LCX-dis	4.0 (3.0-4.0)	3.0 (2.0-3.0)	3.0 (2.875-3.25)	< 0.001	< 0.001	0.03	< 0.001
RCA-dis	4.0 (3.375-4.0)	3.0 (2.0-3.0)	3.0 (2.75-4.0)	< 0.001	< 0.001	0.03	< 0.001
RI	3.5 (2.88-4.0)	2.0 (2.0-2.63)	3.0 (2.0-4.0)	0.009	0.033	0.156	0.21
D	3.0 (3.0-4.0)	2.0 (1.0-3.0)	3.0 (2.0-3.375)	< 0.001	< 0.001	0.009	0.006
OM	4.0 (3.0-4.0)	2.0 (2.0-3.0)	3.0 (2.0-4.0)	< 0.001	< 0.001	0.015	0.09
PDA	3.0 (2.0-4.0)	1.0 (1.0-2.0)	2.0 (2.0-3.0)	< 0.001	< 0.001	0.033	0.006
PLB	3.0 (3.0-4.0)	2.0 (1.0-2.0)	3.0 (2.0-3.0)	< 0.001	0.006	0.042	0.018

¹The Friedman test was used to compare characteristics among balanced turbo field echo, turbo field echo, and modified Dixon.

²Balanced turbo field echo vs turbo field echo.

³Balanced turbo field echo vs modified Dixon.

⁴Turbo field echo vs modified Dixon.

NA: Not available; BTFE: Balanced turbo field echo; TFE: Turbo field echo; mDixon: Modified Dixon; LM: Left main artery; LAD-pro: Proximal left anterior descending artery; LAD-mid: Mid left anterior descending artery; LAD-dis: Distal left anterior descending artery; LCX-pro: Proximal left circumflex artery; LCX-dis: Distal left circumflex artery; RCA-pro: Proximal right coronary artery; RCA-mid: Mid right coronary artery; RCA-dis: Distal right coronary artery; RI: Ramus intermediu; D: The first and second diagonal branches (D1, D2); OM: The first and second obtuse marginal branches (OM1, OM2); PDA: Posterior descending arteries; PLB: Posterolateral branches.

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Table 3 Comparison of vessel assessability rates of non-contrast coronary magnetic resonance angiography sequences at balanced turbo field echo, turbo field echo, and modified Dixon in 22 participants, n (%)

Segment	No. of all segments	No. of assessable segment (score ≥ 2)
Segment	No. of all segments	BTFE	TFE	mDixon
Overall	284	282 (99.3)	247 (87.0)	271 (95.4)
LM	22	22 (100)	22 (100)	22 (100)
LAD-pro	22	22 (100)	22 (100)	22 (100)
LCX-pro	22	22 (100)	22 (100)	22 (100)
RCA-pro	22	22 (100)	22 (100)	22 (100)
LAD-mid	22	22 (100)	22 (100)	22 (100)
RCA-mid	22	22 (100)	21 (95.5)	21 (95.5)
LAD-dis	22	22 (100)	22 (100)	22 (100)
LCX-dis	22	22 (100)	20 (90.9)	22 (100)
RCA-dis	22	22 (100)	20 (90.9)	21 (95.5)
RI	10	10 (100)	9 (90.0)	9 (90.0)
D	24	24 (100)	14 (58.3)	20 (83.3)
OM	20	20 (100)	16 (80)	19 (95.0)
PDA	18	17 (94.4)	7 (38.9)	15 (83.3)
PLB	14	13 (92.9)	8 (57.1)	12 (85.7)

BTFE: Balanced turbo field echo; TFE: Turbo field echo; mDixon: Modified Dixon; LM: Left main artery; LAD-pro: Proximal left anterior descending artery; LAD-mid: Mid left anterior descending artery; LAD-dis: Distal left anterior descending artery; LCX-pro: Proximal left circumflex artery; LCX-dis: Distal left circumflex artery; RCA-pro: Proximal right coronary artery; RCA-mid: Mid right coronary artery; RCA-dis: Distal right coronary artery; RI: Ramus intermediu; D: The first and second diagonal branches (D1, D2); OM: The first and second obtuse marginal branches (OM1, OM2); PDA: Posterior descending arteries; PLB: Posterolateral branches.

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Table 4 Quantitative image quality metrics and mean acquisition time for balanced turbo field echo, turbo field echo, and modified Dixon sequences, mean ± SD

Parameter	BTFE	TFE	mDixon	Intergroups P value¹	P value (adjusted P value)²	P value (adjusted P value)³	P value (adjusted P value)⁴
SNR
LM	145.0 ± 12.9	88.68 ± 8.2	109.4 ± 12.2	< 0.001	< 0.001	< 0.001	< 0.001
LAD-pro	139.7 ± 13.6	83.2 ± 7.9	109.4 ± 12.6	< 0.001	< 0.001	< 0.001	< 0.001
LCX-pro	137.2 ± 14.5	80.4 ± 6.3	104.8 ± 12.5	< 0.001	< 0.001	< 0.001	< 0.001
RCA-pro	135.4 ± 8.4	73.3 ± 9.2	94.3 ± 12.0	< 0.001	< 0.001	< 0.001	< 0.001
CNR	-	-	-	< 0.001	< 0.001	< 0.001	< 0.001
LM	83.7 ± 13.6	30.7 ± 6.4	50.2 ± 10.6	< 0.001	< 0.001	< 0.001	< 0.001
LAD-pro	78.2 ± 12.4	25.1 ± 5.8	50.1 ± 11.7	< 0.001	< 0.001	< 0.001	< 0.001
LCX-pro	75.7 ± 14.0	22.2 ± 7.1	45.5 ± 14.0	< 0.001	< 0.001	< 0.001	< 0.001
RCA-pro	74.1 ± 12.1	15.4 ± 6.7	35.1 ± 8.6	< 0.001	< 0.001	< 0.001	< 0.001
VES⁵	-	-	-	< 0.001	< 0.001	< 0.001	< 0.001
LM	257.3 ± 31.0	150.2 ± 19.3	80.5 ± 14.0	< 0.001	< 0.001	< 0.001	< 0.001
LAD-pro	266.1 ± 34.9	149.6 ± 14.2	82.1 ± 10.8	< 0.001	< 0.001	< 0.001	< 0.001
LCX-pro	276.6 ± 33.9	141.1 ± 13.0	76.9 ± 7.4	< 0.001	< 0.001	< 0.001	< 0.001
RCA-pro	284.1 ± 35.8	143.4 ± 13.5	79.7 ± 9.8	< 0.001	< 0.001	< 0.001	< 0.001
Vessel length (mm)
LAD	126 ± 10	114 ± 17	118 ± 17	< 0.001	< 0.001	0.016	0.017
LCX	77 ± 10	75 ± 8	76 ± 9	0.002	0.017	0.074	0.459
RCA	122 ± 7	120 ± 7	121 ± 7	< 0.001	0.002	0.043	0.038
Acquisition time (minute)	6.13 ± 1.00	7.15 ± 2.02	7.17 ± 1.72	0.015	0.025	0.035	1.000

¹The one-way repeated measures analysis of variance was used to compare characteristics among balanced turbo field echo, turbo field echo, and modified Dixon.

²Balanced turbo field echo vs turbo field echo.

³Balanced turbo field echo vs modified Dixon.

⁴Turbo field echo vs modified Dixon.

⁵Vessel edge sharpness was computed as the maximum normalized gradient of the signal-intensity profile perpendicular to the vessel wall, using a gradient-based algorithm implemented in Matrix Laboratory (R2019a; MathWorks).

SNR: Signal-to-noise ratio; CNR: Contrast-to-noise ratio; VES: Vessel edge sharpness; BTFE: Balanced turbo field echo; TFE: Turbo field echo; mDixon: Modified Dixon; LM: Left main artery; LAD: Left anterior descending artery; LCX: Left circumflex artery; RCA: Right coronary artery; LAD-pro: Proximal left anterior descending artery; LCX-pro: Proximal left circumflex artery; RCA-pro: Proximal right coronary artery.

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Table 5 Inter- and intra-observer agreements in the scoring of image quality among three different sequences

Score of vessel segments	Reader 1	Reader 2	Interobserver kappa (95%CI)	Reader 1 repeat	Intraobserver kappa (95%CI)
LM	4.0 (3.0-4.0)	4.0 (3.0-4.0)	0.887 (0.763-1.012)	4.0 (3.0-4.0)	0.924 (0.819-1.028)
LAD-pro	4.0 (3.75-4.0)	4.0 (3.75-4.0)	0.835 (0.679-0.991)	4.0 (4.0-4.0)	0.874 (0.734-1.013)
LCX-pro	4.0 (3.0-4.0)	4.0 (3.0-4.0)	0.901 (0.792-1.010)	4.0 (3.0-4.0)	0.933 (0.843-1.024)
RCA-pro	4.0 (3.0-4.0)	4.0 (3.0-4.0)	0.886 (0.776-0.996)	4.0 (3.0-4.0)	0.914 (0.817-1.010)
LAD-mid	4.0 (3.0-4.0)	4.0 (3.0-4.0)	0.875 (0.766-0.985)	4.0 (3.0-4.0)	0.900 (0.802-0.998)
RCA-mid	4.0 (3.0-4.0)	3.0 (3.0-4.0)	0.887 (0.797-0.978)	3.0 (3.0-4.0)	0.906 (0.824-0.988)
LAD-dis	3.0 (3.0-4.0)	3.0 (3.0-4.0)	0.853 (0.743-0.963)	3.0 (3.0-4.0)	0.872 (0.768-0.976)
LCX-dis	3.0 (2.75-4.0)	3.0 (3.0-4.0)	0.859 (0.753-0.965)	3.0 (3.0-4.0)	0.877 (0.777-0.977)
RCA-dis	3.0 (3.0-4.0)	3.0 (2.0-4.0)	0.872 (0.774-0.969)	3.0 (2.0-4.0)	0.888 (0.796-0.980)
RI	3.0 (2.0-4.0)	3.0 (2.0-3.25)	0.865 (0.740-0.991)	3.0 (2.0-4.0)	0.904 (0.797-1.011)
D	3.0 (2.0-3.0)	3.0 (2.0-3.0)	0.924 (0.865-0.984)	3.0 (2.0-3.0)	0.950 (0.901-0.998)
OM	3.0 (2.0-4.0)	3.0 (2.0-4.0)	0.891 (0.812-0.970)	3.0 (2.0-4.0)	0.938 (0.879-0.998)
PDA	2.0 (1.0-3.0)	2.0 (1.0-3.0)	0.910 (0.836-0.984)	2.0 (1.0-3.0)	0.964 (0.915-1.014)
PLB	3.0 (2.0-3.0)	3.0 (2.0-3.0)	0.884 (0.787-0.981)	3.0 (2.0-3.0)	0.954 (0.892-1.016)

LM: Left main artery; LAD-pro: Proximal left anterior descending artery; LAD-mid: Mid left anterior descending artery; LAD-dis: Distal left anterior descending artery; LCX-pro: Proximal left circumflex artery; LCX-dis: Distal left circumflex artery; RCA-pro: Proximal right coronary artery; RCA-mid: Mid right coronary artery; RCA-dis: Distal right coronary artery; RI: Ramus intermediu; D: The first and second diagonal branches (D1, D2); OM: The first and second obtuse marginal branches (OM1, OM2); PDA: Posterior descending arteries; PLB: Posterolateral branches; CI: Confidence interval.

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Table 6 Inter- and intra-observer agreements in the quantitative image quality and vessel length among three different sequences, mean ± SD

Characteristic	Reader 1	Reader 2	Interobserver ICC (95%CI)	Reader 1 repeat	Intraobserver ICC (95%CI)
SNR
LM	114.4 ± 25.9	115.6 ± 23.0	0.957 (0.931-0.974)	114.4 ± 24.0	0.989 (0.982-0.993)
LAD-pro	110.8 ± 25.9	112.9 ± 30.7	0.966 (0.943-0.979)	111.4 ± 23.7	0.985 (0.976-0.991)
LCX-pro	107.4 ± 26.1	107.3 ± 22.4	0.956 (0.930-0.973)	108.4 ± 23.6	0.986 (0.977-0.991)
RCA-pro	103.6 ± 27.6	101.4 ± 26.6	0.975 (0.959-0.985)	103.8 ± 24.6	0.989 (0.968-0.995)
CNR
LM	54.9 ± 24.2	57.2 ± 28.7	0.951 (0.918-0.970)	55.9 ± 28.0	0.973 (0.956-0.983)
LAD-pro	51.2 ± 24.1	51.1 ± 20.2	0.948 (0.916-0.968)	52.1 ± 21.8	0.984 (0.973-0.990)
LCX-pro	47.8 ± 25.1	50.1 ± 28.8	0.952 (0.920-0.971)	48.8 ± 28.1	0.973 (0.957-0.984)
RCA-pro	41.5 ± 26.3	43.3 ± 27.0	0.971 (0.951-0.982)	43.3 ± 27.7	0.982 (0.967-0.990)
VES
LM	162.7 ± 76.6	155.7 ± 65.9	0.951 (0.917-0.971)	159.6 ± 75.4	0.983 (0.972-0.989)
LAD-pro	166.0 ± 79.8	159.0 ± 69.2	0.958 (0.927-0.975)	162.9 ± 78.2	0.984 (0.974-0.990)
LCX-pro	164.9 ± 86.5	161.5 ± 77.2	0.979 (0.966-0.987)	161.2 ± 81.0	0.985 (0.975-0.991)
RCA-pro	169.1 ± 88.9	162.0 ± 82.7	0.985 (0.964- 0.992)	160.9 ± 84.6	0.989 (0.949-0.996)
Vessel length (mm)
LAD	119.2 ± 16.0	119.3 ± 16.0	0.997 (0.994-0.998)	118.7 ± 16.2	0.999 (0.999-1.000)
LCX	76.1 ± 9.1	75.9 ± 9.8	0.984 (0.975-0.990)	76.2 ± 9.7	0.989 (0.982-0.993)
RCA	121.4 ± 7.2	122.4 ± 7.2	0.978 (0.908-0.991)	121.5 ± 7.2	0.996 (0.994-0.998)

ICC: Intraclass correlation coefficients; CI: Confidence interval; SNR: Signal-to-noise ratio; CNR: Contrast-to-noise ratio; VES: Vessel edge sharpness; LM: Left main artery; LAD: Left anterior descending artery; LCX: Left circumflex artery; RCA: Right coronary artery; LAD-pro: Proximal left anterior descending artery; LCX-pro: Proximal left circumflex artery; RCA-pro: Proximal right coronary artery.

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Citation: Wei CW, Zhang RZ, Xu Y, Liu JY, Zhang N, Xu L, Wen ZY. 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. World J Radiol 2026; 18(2): 115741
URL: https://www.wjgnet.com/1949-8470/full/v18/i2/115741.htm
DOI: https://dx.doi.org/10.4329/wjr.v18.i2.115741