CMR of vascular disease

Vascular disease comprises a heterogeneous group of conditions which are increasing in prevalence, due to an ageing population, and also in complexity as new treatment options emerge. Imaging is pivotal not only for diagnosis, but also for determining optimal management, including timing and type of intervention when appropriate. Several imaging modalities are routinely used in the assessment of vascular disease, including invasive angiography, ultrasound, computed tomography (CT), and cardiovascular magnetic resonance (CMR), each with its own advantages and limitations. The indications for CMR include the initial evaluation of vascular disease, and in particular serial monitoring. Multi-planar acquisition by CMR allows for the complete coverage of the vessels, and cine imaging enables the coupling of anatomical with functional information which can be extended to the heart for an integrated perspective. Tissue characterization infers different components of the vessel wall, but calcification is not well appreciated by CMR as it is by CT. Despite these advantages, the requirement for breath-holds in most acquisitions, relatively long study times, and incompatibility with some medical equipment in a magnetic environment limit its use in the unstable patient.