Advances in clinical applications of cardiovascular magnetic resonance imaging

Cardiovascular magnetic resonance (CMR) imaging is unsurpassed in the evaluation of myocardial anatomy, function and mass. Myocardial perfusion pre- and post-stress, as well as late enhancement is increasingly used in the work-up for ischemic heart disease, especially in establishing the presence of myocardial viability. Late enhancement patterns can contribute substantially to the diagnosis of myocarditis and various cardiomyopathies as well as infiltrative diseases and tumors. The quality of CMR imaging has consequently improved dramatically since the first MR images of the human heart were described more than 20 years ago, and it is still advancing apace. CMR now represents one of the most versatile, non-invasive imaging modalities available, offering high spatial resolution and image contrast along with tissue characterization and hemodynamic assessment, without applying ionizing radiation, and with complete multiplanar coverage of the heart.Good communication between the referring physician and the CMR specialist is paramount to streamline the type and order of sequences required for each particular scenario. Although new sequences are constantly being developed, the basic principles of CMR remain unaltered.Imaging speed is likely to continue to increase and larger and larger imaging volumes will become accessible at any given spatial and temporal resolution. The ability to accurately assess total scar burden via T1 mapping could provide a more objective method of non-invasively quantifying diffuse myocardial fibrosis, as recent studies have validated this method in various myocardial diseases.Quantitative analysis of perfusion studies will become easier and more applicable in the clinical setting. Myocardial tagging, enabling the CMR specialist to quantify diastolic wall motion will probably move from the research environment into clinical practice. Although coronary artery imaging via CMR is still in its infancy, the imaging of carotid plaque composition looks promising; especially in evaluating the response to lipid-lowering drugs. Plaque characterization with 3.0-T MRCA will probably play an important role in the diagnosis and risk stratification of CAD in the future.