Comparison between Dark-Blood LGE Sequence and Standard Bright-Blood LGE in the Assessment of Ventricular Myocardial...

Purpose To perform a meta-analysis of the head-to-head performance of dark-blood (DB) late gadolinium enhancement (LGE) and bright-blood (BB) LGE for myocardial scar detection. Materials and Methods This systematic review and meta-analysis included studies identified from PubMed, Embase, and the Cochrane Library, from database inception through October 2025, in which both DB LGE and BB LGE were acquired in the same patient sample. In eligible studies, at least one prespecified outcome (per-segment or per-patient LGE detection, papillary enhancement, scar-to-blood contrast-to-noise ratio [CNR], or reader confidence) was reported. Outcomes were pooled as odds ratios (ORs), mean differences (MDs), or standard MDs (SMDs) using a random-effects model, and heterogeneity was assessed with the I² statistic. Subgroup analyses according to LGE etiology were performed when data permitted. Results Twenty-three studies including 1823 patients were analyzed. DB LGE was associated with higher overall segment-level LGE detection (OR, 1.26 [95% CI: 1.10, 1.44]), overall per-patient LGE detection (OR, 1.19 [95% CI: 1.01, 1.40]), ischemic segment-level detection (OR, 1.31 [95% CI: 1.15, 1.49]), and papillary muscle LGE detection (OR, 2.82 [95% CI: 1.81, 4.42]). DB LGE was also associated with a higher scar-to-blood CNR (MD, 10.48 [95% CI: 5.95, 15.01]) and greater reader confidence in the detection of ischemic LGE (SMD, 0.72 [95% CI: 0.23, 1.20]). Conclusion DB LGE was associated with higher myocardial scar detection and greater scar-to-blood contrast than BB LGE, particularly for ischemic patterns and papillary muscle fibrosis. Keywords: MR Imaging, Cardiac, Heart, Myocardium, Ischemia/Infarction, Technical Aspects, Meta-Analysis, Cardiac Magnetic Resonance, Late Gadolinium Enhancement, Dark Blood, Bright Blood Supplemental material is available for this article. © RSNA, 2026.