Cardiac MRI: State of the Art

Cardiac MRI plays an important role in the evaluation of cardiovascular diseases (CVDs), including ischemic heart disease, cardiomyopathy, valvular disease, congenital disease, pericardial disease, and masses. Large multicenter trials have shown the positive impact of MRI-based management on outcomes in several CVDs. These results have made MRI an indispensable technique in the evaluation of these diseases, and cardiac MRI has an important role in multisociety guidelines. MRI is the reference standard for quantification of ventricular volumes and function. Flow imaging enables accurate quantification of flow and velocities through valves, shunts, and surgical conduits or baffles. Late gadolinium enhancement and parametric mapping techniques enable tissue characterization and yield prognostic information. In the past decade, cardiac MRI technology has seen rapid advances in both hardware and sequences. Multiple novel sequences, such as parametric mapping and four-dimensional flow, are increasingly being incorporated into routine clinical practice. Acceleration strategies have matured, allowing faster acquisition of cardiac MRI sequences in patients with arrhythmia and poor breath holding. Challenges of cardiac MRI at high-field-strength magnets and in patients with indwelling cardiac devices or severe renal dysfunction have been mitigated. Artificial intelligence techniques are decreasing the complexity of MRI acquisition and postprocessing. This article reviews the current state of the art and emerging techniques in cardiac MRI.