Image Quality and Reproducibility of Three-Dimensional Black-Blood Magnetic Resonance Imaging for Thoracic Aortic Imaging: A Systematic Review

Background Three-dimensional black-blood MRI has emerged as a promising technique for aortic vessel wall assessment, offering high-resolution imaging without ionizing radiation. However, despite growing technical maturity, its clinical adoption remains limited. This gap reflects not only technical barriers but also insufficient radiologist training and familiarity with the capabilities and limitations of 3D black-blood MRI. This systematic review evaluates current evidence on reproducibility and image quality of 3D black-blood MRI for thoracic aortic imaging. Methods A comprehensive literature search was performed in PubMed, Embase, Scopus, Web of Science, and Google Scholar to identify eligible studies published up to 1st August 2025. Studies using three-dimensional black-blood MRI sequences for evaluation of the thoracic aorta were included. The primary outcomes were image quality and measurement reproducibility. Results Twelve studies comprising 354 participants were included. Reproducibility was reported in five studies, demonstrating good to excellent agreement for quantitative vessel wall measurements (intraclass correlation coefficients (ICCs) 0.71–0.99) and substantial to near-perfect agreement for categorical assessments (κ 0.85–1.00). Image quality was evaluated in eight studies and was consistently rated as good to excellent. Study quality assessment revealed an overall low risk of bias, with high methodological quality in studies reporting reproducibility. Conclusion Three-dimensional black-blood MRI techniques demonstrate high reproducibility and excellent image quality for thoracic aortic imaging and may promise for early detection and longitudinal assessment of aortic disease. However, broader clinical adoption will require targeted radiologist education, standardized training frameworks, and improved awareness of technique-specific strengths and limitations.