The validity of a free breathing motion corrected phase sensitive inversion recovery sequence in the detection of delayed myocardial enhancement in non-ischemic heart disease

Background Breath-hold (BH) segmented TURBO FLASH (TFL) is currently used as the gold standard technique to evaluate delayed enhancement (DE) of the myocardium, typically with a phase sensitive inversion recovery (PSIR) approach (1). However, many patients are unable to perform adequate breath-holding resulting in poor image quality and limited diagnostic yield. Free breathing (FB) single shot steady state free precession (SSFP) is used as an alternative approach however respiratory motion artifact with resultant blurring may affect visualization of smaller myocardial scars. FB motion corrected (MOCO) single shot SSFP with averaging (2) has been shown to be equal or superior in detecting myocardial infarction (3), particularly in vulnerable patients. For FB MOCO sequences to replace current BH techniques in the detection of DE, they must be sensitive to the detection of both ischemic and non-ischemic patterns of delayed enhancement.