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Reference bright\u2010blood late gadolinium enhancement (LGE) imaging provides poor scar\u2010to\u2010blood contrast, making PMI visualization challenging. Black\u2010blood LGE imaging overcomes this limitation by improving the blood\u2010scar contrast.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate a recent co\u2010registered bright\u2010 (papillary muscle localization) and black\u2010blood (PMI visualization) sequence (Scar\u2010specific imaging with Preserved myOcardial visualizaTion: SPOT) to improve PMI visualization compared to a reference standard phase\u2010sensitive inversion recovery (PSIR) sequence, and to enable automated PMI detection (auto\u2010PMI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Type<\/jats:title><jats:p>Retrospective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>198 patients with ischemic heart disease were divided into an optimization dataset (<jats:italic>N<\/jats:italic>\u2009=\u2009127) and a testing dataset (<jats:italic>N<\/jats:italic>\u2009=\u200971).<\/jats:p><\/jats:sec><jats:sec><jats:title>Field Strength\/Sequence<\/jats:title><jats:p>2D SPOT and PSIR balanced steady\u2010state free precession sequences at 1.5\u2009T.<\/jats:p><\/jats:sec><jats:sec><jats:title>Assessment<\/jats:title><jats:p>Auto\u2010PMI included: image acquisition, slice selection, endocardial segmentation, blood pool preprocessing, and PMI detection. Three radiologists (8, 5 and 2\u2009years of MRI experience) assessed PMI in SPOT and PSIR images independently. A consensus reading regarding all assessments of both sequences was established. The number of patients with PMI in SPOT and PSIR acquisitions was compared. The diagnostic performances of visual (SPOT and PSIR) and auto\u2010PMI (SPOT) detection were evaluated. Inter\u2010 and intra\u2010observer reproducibility of the visual PMI detection was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Statistical Tests<\/jats:title><jats:p>McNemar test, <jats:italic>p<\/jats:italic>\u2010value &lt;\u20090.05 was considered statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the testing dataset, significantly more patients with PMI were detected using SPOT compared to PSIR in each session (37 vs. 27, 36 vs. 29, 41 vs. 31, 42 vs. 25). Sensitivity ranges for visual PMI detection were significantly higher using SPOT (89%\u2013100% vs. 61%\u201382%). SPOT vs. PSIR inter\u2010 and intra\u2010observer reproducibility ranges were 77%\u201380% vs. 71%\u201377%, and 97% vs. 88%, respectively. Auto\u2010PMI sensitivity was 87%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Conclusion<\/jats:title><jats:p>Co\u2010registered bright\u2010 and black\u2010blood SPOT imaging improved visual PMI detection and facilitated automated PMI assessment.<\/jats:p><jats:p>\n<jats:bold>Evidence Level:<\/jats:bold> 3.<\/jats:p><jats:p>\n<jats:bold>Technical Efficacy:<\/jats:bold> Stage 2.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmri.29777","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T12:24:58Z","timestamp":1744201498000},"page":"827-839","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Improved and Automated Detection of Papillary Muscle Infarction Using Joint Bright\u2010 and Black\u2010Blood Late Gadolinium Enhancement 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