This study tested cardiac MRI cardiac quantitative susceptibility mapping (QSM) for measurement of mitral annular calcification (MAC) using the reference of computed tomography (CT). QSM entailed a free-breathing ECG-triggered multi-echo 3D GRE sequence with diaphragmatic navigation via ECG-gating (1D respiratory navigator, 4mm window, acquisition time ~7 minutes, navigator efficiency 36%, spatial resolution 1.5×1.5×5mm3). Among 24 patients undergoing MRI and CT (mean 3.9±3.4 months), annular susceptibility decreased stepwise (p<0.001) and R2* increased (p<0.05) among patients stratified by CT mitral annular calcium score. Both QSM (AUC=0.950, p=0.005) and R2* (AUC=0.938, p=0.007) yielded excellent diagnostic performance for advanced mitral annular calcification on CT.
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