Key result
Ultrafast 3-D CMR proves non-inferior to standard 2-D CMR for LVEF, cutting scan time ~90%.
Why the study?
Long acquisition times and multiple breath-holds pose significant challenges in pediatric CMR, motivating evaluation of a novel 3-D ultrafast protocol against the conventional 2-D gold standard.
Does a novel 3-D ultrafast CMR protocol provide non-inferior assessment of cardiac function and strain compared to the 2-D gold standard in adolescents?
Cross-Sectional (n=39)
Single-blind
No
Does a novel 3-D ultrafast CMR protocol provide non-inferior assessment of cardiac function and strain compared to the 2-D gold standard in adolescents?
Effect estimate: Mean difference -1.2% (95% CI -2.69 to 0.29)
A novel 3-D ultrafast CMR protocol provides non-inferior quantitative assessment of cardiac function and strain in adolescents compared to the 2-D gold standard, while reducing scan time by approximately 90%.
May support abbreviated CMR in adolescents; leaves open prospective validation before practice change.
BACKGROUND: Cardiac magnetic resonance (CMR) is the gold standard for assessing cardiac anatomy and function. However, long acquisition times and multiple breath-holds pose significant challenges in pediatric imaging. OBJECTIVE: To perform a non-inferiority analysis comparing a novel 3-dimensional (D) ultrafast CMR protocol against the conventional 2-dimensional (D) gold standard for evaluating cardiac function, strain, and tissue characterization in adolescents. MATERIALS AND METHODS: Thirty-nine adolescents (mean age 12.2±2.6 years) underwent both a standard 2-D protocol and a 3-D ultrafast protocol at 3-T. The 3-D protocol comprised enhanced sensitivity encoding by static outer volume subtraction (ESSOS) cine and 3-D late gadolinium enhancement. Image quality and diagnostic confidence were compared. A pre-specified non-inferiority margin (Δ) was used to assess functional and strain parameters. Agreement was evaluated using Bland-Altman analysis and intraclass correlation coefficients (ICCs). RESULTS: The total scan time was significantly shorter for the 3-D protocol compared to the 2-D protocol (75.8±10.0 s vs. 734.4±19.6 s, P<0.05). Image quality scores were comparable between protocols (median score 4.0, P=0.74). The 3-D protocol demonstrated statistical non-inferiority for all functional and strain metrics. Bland-Altman analysis showed minimal bias for key parameters, and the 95% confidence intervals for differences met the pre-specified non-inferiority margins. Intraclass correlation coefficients (ICCs) indicated good to excellent agreement for all parameters (n=39). CONCLUSION: The novel 3-D ultrafast CMR protocol is non-inferior to the conventional 2-D gold standard for quantitative assessment of cardiac function and strain in adolescents. It offers comparable image quality with significantly reduced acquisition times, potentially improving clinical feasibility in pediatric populations.
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Chen et al. (2026) conducted a cross-sectional in Cardiovascular disease requiring cardiac magnetic resonance (n=39). 3-D ultrafast CMR protocol (ESSOS + 3-D late gadolinium enhancement) vs. Conventional 2-D CMR protocol was evaluated on Left ventricular ejection fraction (LVEF) non-inferiority (Mean difference -1.2%, 95% CI -2.69 to 0.29). The 3-D ultrafast CMR protocol was non-inferior to the 2-D gold standard for left ventricular ejection fraction (mean difference -1.2%) and reduced total scan time from 734.4 s to 75.8 s.
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