Advancements in Contrast-enhanced Thoracic MR Angiography

There is a clinical need for high-spatial-resolution, electrocardiography (ECG)-gated, respiratory-navigated contrast-enhanced (CE) thoracic MR angiography (MRA; hereafter, NAV CE MRA) robust to physiologic motion artifacts. Compared with first-pass gated techniques, ECG-triggered NAV MRA more effectively suppresses motion and exhibits greater acquisition efficiency and/or artifact mitigation than non-CE MRA. Gradient-echo or balanced steady-state free precession NAV CE MRA has conventionally used diaphragmatic navigators to minimize respiratory motion and parallel imaging for acquisition acceleration. The development of image-based navigators (iNAVs) and variable golden-step Cartesian trajectory with spiral profile order sampling represents a progressive technologic innovation for three-dimensional thoracic CE MRA (hereafter, iNAV CE MRA). iNAV CE MRA can also be combined with time-resolved angiography and abdominopelvic first-pass CE MRA for dynamic information and/or extended anatomic coverage. In this review, we describe techniques for NAV CE MRA motion correction, contrast agent considerations, noncontrast alternatives, use in clinical applications, limitations, and future potential. Keywords: MR Angiography, Congenital, Aorta, Pulmonary Veins, Motion Correction, Aortic Disease, Congenital Heart Disease, Pulmonary Vein Angiography, Variable Density Sampling Supplemental material is available for this article. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.