Balanced SSFP achieves high SNR efficiency, but suffers from bright fat signal. In this work, a multiple-acquisition fat-water separation technique using alternating repetition time (ATR) balanced SSFP is proposed. The SSFP profile can be modified using alternating repetition times and appropriate phase cycling to yield two spectra where fat and water are in-phase and out-of-phase, respectively. The signal homogeneity and the broad width of the created in-phase and out-of-phase profiles lead to signal cancellation over a broad stop-band. The stop-band suppression is achieved for a wide range of flip angles and tissue parameters. This property, coupled with the inherent flexibility of ATR SSFP in repetition time selection, makes the method a good candidate for fat-suppressed SSFP imaging. The proposed method can be tailored to achieve a smaller residual stop-band signal or a decreased sensitivity to field inhomogeneity depending on application-specific needs. (c) 2008 Wiley-Liss, Inc.