Left atrial late gadolinium enhancement with water–fat separation: The importance of phase‐encoding order

PURPOSE: To compare two late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) methods: a Dixon LGE sequence with sequential phase-encoding order, reconstructed using water-fat separation, and standard fat-saturated LGE. MATERIALS AND METHODS: We implemented a dual-echo Dixon LGE method for reconstructing water-only images and compared it to fat-saturated LGE in 12 patients prior to their first pulmonary vein isolation (PVI) procedure. Images were analyzed for quality and fat-suppression. Regions of the left atrium were evaluated by a blinded observer (1 = prominent enhancement, 0 = mild or absent enhancement) on two sets of images (fat-saturated and water-only LGE) and agreement was assessed. RESULTS: Water-only LGE showed a trend toward better fat-suppression (P = 0.06), with a significantly more homogeneous blood pool signal and reduced inflow artifacts (both P < 0.01). Agreement between fat-saturated LGE and water-only methods was found in 84% of regions, significantly correlated by chi-squared test (P < 0.001). The kappa value was 0.52 (moderate). The average number of enhancing segments was higher for fat-saturated LGE than water-only LGE (4.2 ± 2.7 vs. 3.2 ± 2.9, P = 0.03). CONCLUSION: The two-point Dixon LGE technique reduces artifacts due to a centric k-space order. A similar enhancement pattern was observed irrespective of the LGE technique, with more enhancement detected by fat-saturated LGE.