Original Research Balanced Steady-State Free Precession vs. Segmented Fast Low-Angle Shot for the Evaluation of Ventricular Volumes, Mass, and Function at 3 Tesla Frank Grothues, MD, 1 * Hagen Boenigk, MD, 1 Joachim Graessner, MS, 2 Martin Kanowski, PhD, 3 and Helmut U. Klein, MD 1 Purpose: To compare balanced steady-state free preces- sion (SSFP) and segmented fast low angle shot (FLASH) for quantification of left and right ventricular volumes and function and for left ventricular mass at high field (3 Tesla). Materials and Methods: A total of 33 patients (19 male, mean age 54 years) with various forms of heart disease underwent ventricular function studies using cine SSFP and FLASH sequences with identical slice orientations. Results: Using SSFP, left ventricular end-diastolic (+10 mL [4.7%], P  0.001) and end-systolic volumes (+9 mL [6.1%], P  0.001) measured larger whereas mass was consider- ably smaller (–23 g [–12.9%], P  0.001) and ejection frac- tion (–1% [–3.2%], P  0.01) marginally smaller. Right ven- tricular end-diastolic (+4 mL [2.6%], P = 0.001) and end- systolic volumes (+4 mL [5.1%], P  0.01) were also larger, but no significant difference for right ventricular ejection fraction (P = 0.05) was found. Conclusion: Similar to previous results at 1.5 Tesla, at high magnetic field the cine SSFP technique led to discrete but significantly higher ventricular volume measurements and to a significantly smaller measurement of left ventric- ular mass in patients. The effect on left and right ventric- ular ejection fraction was minor, although the difference remained significant for the left ventricle. Key Words: cardiac magnetic resonance; high field; cine imaging; SSFP; FLASH J. Magn. Reson. Imaging 2007;26:392– 400. © 2007 Wiley-Liss, Inc. NOWADAYS, breathhold cine bright blood imaging for measurement of ventricular volumes, ejection fraction, and mass represents an essential part of most cardiac magnetic resonance studies. The fast low-angle shot (FLASH) technique based on spoiled gradient echo se- quences was introduced in 1986 (1); in its segmented form it has been applied for more than a decade (2) and it has proven to be both accurate (3,4) and reproducible (5,6). During the past years, balanced steady state free precession techniques (SSFP) have emerged as the standard technique for assessing cardiac function at 1.5 T (7,8). Vendor-specific, they have been named ei- ther true fast imaging with steady-state precession (trueFISP), balanced fast-field echo (bFFE), or fast im- aging employing steady-state acquisition (FIESTA). Im- aging occurs by rephasing transverse magnetization when all transverse and longitudinal magnetization components are at steady state (7). This results in ac- quisitions that provide excellent contrast between oxy- genated blood and myocardium at a high signal-to- noise ratio (SNR) (9), which in contrast to FLASH techniques are mainly dependent on the tissue to blood T 1 /T 2 ratio and not on the inflow of unsaturated blood (10). Various studies at 1.5 T have compared FLASH and SSFP techniques for the quantitative analysis of ventricular volumes, mass, and ejection fraction. Con- sistently, SSFP imaging led to larger volumes and smaller left ventricular myocardial mass with only a small effect on left ventricular ejection fraction (11–15). These differences have led to the development of differ- ent normal values for FLASH (16,17) and SSFP (17–19) techniques. Recently, imaging at high field (3 T) has been intro- duced and is now increasingly used for cardiac appli- cations. However, data to confirm whether the experi- ences made at 1.5 T hold true at high field (3 T) are currently not available. The expected increase in SNR at 3 T might benefit both the FLASH and the SSFP tech- nique, whereas various kinds of artifacts, especially due to static field inhomogeneities, can negatively in- fluence image quality with SSFP (20,21). Hence, the purpose of this study was to directly compare and to 1 Department of Cardiology, Otto-von-Guericke-University, Magdeburg, Germany. 2 Siemens AG Medical Solutions, Erlangen, Erlangen, Germany. 3 Department of Neurology II, Otto-von-Guericke-University, Magde- burg, Germany. *Address reprint requests to: F.G., Department of Cardiology, Otto-von- Guericke-University, Leipziger Strasse 44, D-39120 Magdeburg, Ger- many. E-mail: frank.grothues@medizin.uni-magdeburg.de Received May 9, 2006; Accepted February 16, 2007. DOI 10.1002/jmri.20986 Published online in Wiley InterScience (www.interscience.wiley.com). JOURNAL OF MAGNETIC RESONANCE IMAGING 26:392– 400 (2007) © 2007 Wiley-Liss, Inc. 392