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Cardiac MRI evaluation of myocardial disease
  1. Gabriella Captur1,2,
  2. Charlotte Manisty3,4,
  3. James C Moon2,3,4
  1. 1UCL Biological Mass Spectrometry Laboratory, Institute of Child Health and Great Ormond Street Hospital, London, UK
  2. 2NIHR University College London Hospitals Biomedical Research Centre, Maple House Suite A, 149 Tottenham Court Road, London, UK
  3. 3UCL Institute of Cardiovascular Science, University College London, London, UK
  4. 4The Cardiovascular Magnetic Resonance Imaging Unit and The Center for Rare Cardiovascular Diseases Unit, Barts Heart Center, St Bartholomew's Hospital, London, UK
  1. Correspondence to Professor James C Moon, Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK; j.moon{at}ucl.ac.uk

Abstract

Cardiovascular magnetic resonance (CMR) is a key imaging technique for cardiac phenotyping with a major clinical role. It can assess advanced aspects of cardiac structure and function, scar burden and other myocardial tissue characteristics but there is new information that can now be derived. This can fill many of the gaps in our knowledge with the potential to change thinking, disease classifications and definitions as well as patient care. Established techniques such as the late gadolinium enhancement technique are now embedded in clinical care. New techniques are coming through. Myocardial tissue characterisation techniques, particularly myocardial mapping can precisely measure tissue magnetisation—T1, T2, T2* and also the extracellular volume. These change in disease. Key biological pathways are now open for scrutiny including focal fibrosis (scar) and diffuse fibrosis, inflammation, metabolism and infiltration. Other new areas to engage in where major insights are growing include detailed assessments of myocardial mechanics and performance, spectroscopy and hyperpolarised CMR. In spite of the advances, challenges remain, particularly surrounding utilisation, technical development to improve accuracy, reproducibility and deliverability, and the role of multidisciplinary research to understand the detailed pathological basis of the MR signal changes. Collectively, these new developments are galvanising CMR uptake and having a major translational impact on healthcare globally and it is steadily becoming key imaging tool.

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