Table 1.

Overview of most common CMR sequences

	Sequence characteristics	Applications	Limitations
Native imaging (without contrast injection)
Cine imaging	Balanced-SSFP (segmented, ECG-gated, multiple cardiac phases) Possible 3D acquisition (but lower spatial/temporal resolution, longer acquisition times)	LV/RV volumes, systo/diastolic function, wall thickness, LV/RV mass Banding (“India Ink”) artifacts highlight fat/water boundaries (e.g. fat infiltration)	Susceptibility to magnetic field inhomogeneities (e.g. metal implants, poor shimming) Acquired over multiple heartbeats (limited by irregular RR-intervals or breathing movements) Lower temporal resolution than echocardiography
	Spoiled-GRE (segmented, ECG-gated, multiple cardiac phases)	Used in case of metal implants (lower susceptibility to metal artifacts)	Lower contrast (blood-to-myocardium) resolution Limited by arrhythmias/ breathing movements (similarly to SSFP cine)
	Real-time GRE or SSFP (single-shot, ungated, multiple cardiac phases)	Used to track beat-to-beat cardiac motion (e.g. septal movements in suspected tamponade/ constrictive physiology; diaphragmatic movements in suspected paralysis)	Low spatial and temporal resolution
Black-blood imaging	T1- or PD- or T2-weighted double-IR FSE (segmented or single-shot, ECG-gated, triggered to a single diastolic cardiac phase)	LV/RV morphology and tissue-characterization (e.g. fatty infiltration) T2-weighted fat-saturated IR-FSE used as an alternative to T2-weighted STIR sequences for oedema detection	Still fluids (subendocardial bloodpool, effusions…) appear hyperintense
STIR	T2-weighted triple-IR FSE (segmented or single-shot, ECG-gated, triggered to a single diastolic cardiac phase)	Intra/extracellular oedema, such as in inflammation and acute necrosis (qualitative/ semiquantitative detection of hyperintense areas) Markedly hypointense areas correspond to myocardial haemorrage or calcifications	Quantification of oedema is time consuming Cardiac segments close to the surface coil may appear hyperintense Still fluids (subendocardial bloodpool, effusions…) appear hyperintense
T1-mapping	MOLLI (8–11 single-shot, ECG-gated IR-SSFP images, all acquired at the same systolic or diastolic cardiac phase with different TIs) Other IR- or SR- sequences are possible alternatives	Native T1 (quantitative): increased by inflammation, oedema, vasodilation, fibrosis, amyloid; decreased by fat, iron	Limited spatial resolution Needs motion correction algorithms (image misalignment may cause incorrect T1 calculation)
T2-mapping	MESE (Multi echo spin echo), GraSE (Gradient echo spin echo) or T2-prepared bSSFP: 3–4 images, all acquired at the same systolic or diastolic cardiac phase with different T2-weighing	Native T2 (quantitative); increased by inflammation, oedema; decreased by iron	Limited spatial resolution Needs motion correction algorithms (image misalignment may cause incorrect T1 calculation)
T2*-mapping	GRE multiecho: 6–8 segmented, ECG-gated images, all acquired at the same systolic or diastolic cardiac phase with different T2*-weighing	Native T2* (quantitative); decreased by iron deposition (haemochromatosis, haemorrage)	Limited spatial resolution Susceptibility to magnetic field inhomogeneities (e.g. metal implants, poor shimming)
Phase contrast	Spoiled-GRE (segmented, ECG-gated, multiple cardiac phases) Possible 3D/4D acquisition (but longer acquisition times and motion artifacts)	Flow quantification (quantitative), across cardiac valves, aortic or pulmonary vessels	Limited spatial and temporal resolution compared to Doppler-echocardiography Unsuitable for vessels as small as the coronary arteries Inaccurate in case of magnetic field inhomogeneities
Post-contrast imaging (after Gd-based contrast injection)
Perfusion	IR- or SR-, GRE or SSFP during Gd-based contrast injection	Myocardial perfusion (qualitative/semiquantitative) Quantitative myocardial perfusion with specific dual-bolus or dual-sequence techniques	Limited spatial resolution Possible dark rim artifact in the subendocardial blood-to-myocardium interface
Early enhancement (EGE)	IR GRE or IR-SSFP (segmented or single-shot, ECG-gated, triggered to a single systolic/diastolic cardiac phase), with a TI set to null the thrombus	Intracardiac thrombus detection	Selection of a wrong nulling time makes EGE image inaccurate
Late enhancement (LGE)	IR GRE or IR-SSFP (segmented or single-shot, ECG-gated, triggered to a single systolic/diastolic cardiac phase), with a TI set to null the normal myocardium Possible 3D acquisition (but longer acquisition times and more motion artifacts)	Extracellular Gd deposition (qualitative/semiquantitative, increased by necrosis, fibrosis, amyloid deposition but also intense extracellular oedema) with excellent contrast-to-noise ratio Markedly hypointense areas within LGE correspond to no-reflow areas	Quantification of fibrosis is time consuming Detection of diffuse fibrosis remains challenging Selection of a wrong nulling time makes LGE image inaccurate; PSIR (phase sensitive inversion recovery) LGE less dependent on TI
ECV-mapping	Same as T1 mapping (MOLLI or other sequences)	Extracellular Gd deposition (qualitative): increased by necrosis, amyloidosis, amyloid, but also extracellular oedema	Limited spatial resolution Needs a pre- and post-contrast acquisition, with perfect image fusion Needs blood haematocrit for ECV calculation
Vascular imaging
CEMRA	3D GRE during Gd-based contrast injection Possible time-resolved CEMRA acquisition (but lower spatial resolution)	Aorta and its branches, pulmonary arteries and its branches,	Needs contrast injection ECG-ungated (unsuitable for coronary arteries) Lower spatial resolution than CT
3D-whole heart	3D balanced-SSFP (segmented, ECG-gated, respiratory navigator- gated, triggered to a single cardiac phase)	Coronary artery anatomy Cardiac arterial and venous connection anatomy	Long acquisition time Limited by arrhythmias/ breathing movements

Common CMR sequences are based on an FSE, spoiled-GRE or a SSFP structure (readout), with variable T1/PD/T2 weighing depending on the chosen parameters (flip angle, repetition time, echo time), sometimes preceded by an IR- or SR- prepulse (to selectively invert or saturate specific tissues)

CEMRA, contrast-enhanced magnetic resonance angiography; CT, computed tomography; ECV, extracellular volume; FSE, fast spin-echo; GRE, gradient echo; IR, inversion recovery; LV, left ventricle; MOLLI, modified Look-Locker inversion recovery; PD, proton density; RV, right ventricle; SR, saturation recovery; (b) SSFP, (balanced) steady-state free-precession; STIR, short-tau inversion recovery; TI, inversion time