Cardiovascular magnetic resonance imaging: techniques and clinical applications

Abstract

Cardiovascular magnetic resonance (CMR) has emerged as a cornerstone in assessing a broad spectrum of cardiac conditions, offering unparalleled accuracy in evaluating ventricular volumes, function and myocardial tissue characterization. This chapter provides a comprehensive overview of CMR principles, including basic magnetic resonance physics, imaging sequences and the use of gadolinium-based contrast agents for late gadolinium enhancement and tissue mapping. Clinical applications are discussed across major domains: ischaemic heart disease, cardiomyopathies, inflammatory and infiltrative myocardial disorders, valve disease, congenital heart defects and cardiac masses. CMR enables a precise phenotyping of cardiomyopathies, risk stratification and monitoring of disease progression, while multiparametric imaging facilitates non-invasive ‘tissue biopsy’ for myocarditis, amyloidosis, sarcoidosis and Fabry disease. In valve disease and congenital heart lesions, flow quantification and four-dimensional imaging enhance clinical decision-making and guide surgical timing. CMR helps differentiate benign from malignant cardiac masses, influencing therapeutic strategies. The chapter highlights current guideline-based indications, technical considerations including imaging in patients with cardiac devices or arrhythmias and the prognostic implications of imaging findings.