Introduction

Recent technical developments in cardiovascular imaging have led to a number of options for the non-invasive investigation of cardiovascular disease. Often, the choice of imaging modality comes down to local availability and expertise, as in many clinical scenarios there is not one clearly superior test. This is reflected in current international guidelines and recommendations. The relative advantages and disadvantages of each modality are already well published,1 but for many indications, echocardiography, due to its widespread availability and relative low cost, will remain the initial investigation of choice. Single-photon emission computed tomography (SPECT) is the most widely used perfusion test (for known/suspected coronary artery disease (CAD)) the world over, although increasingly CT coronary angiography (CTCA) is used in low-risk cases as an excellent rule-out test.

Cardiovascular magnetic resonance (CMR) is an established advanced cross-sectional imaging modality for the functional and anatomical assessment of a wide range of cardiovascular diseases. CMR is safe, does not use ionising radiation, provides diagnostic and prognostic information, and guides patient management.2 ,3 The relative duration of the scan time, expense and lack of portability, however, puts the onus on CMR to demonstrate superiority over other imaging modalities. The extensive and growing evidence base for CMR has established it as the reference standard imaging test for many cardiovascular conditions. As such, CMR is firmly established in both national and international clinical guidelines4–7 with recognised international training syllabi and accreditation/certification processes.8–10

CMR demand continues to expand, particularly in the UK, where there was …