Cardiac Magnetic Resonance Imaging (MRI) has become an essential tool in cardiology, enabling detailed and non-invasive evaluation of the heart and blood vessels. Thanks to its ability to provide precise images of cardiac structures, assess myocardial function, and detect pathologies with high reliability, cardiac MRI has become a benchmark for diagnosing and monitoring cardiovascular diseases. Unlike other imaging techniques like X-rays, it offers highly advanced tissue characterization. However, despite its potential, it remains underutilized in certain contexts due to technical and economic constraints.

Physical and technical principles of cardiac MRI

In cardiology, MRI produces dynamic images of the moving heart, allowing precise analysis of myocardial contractility and blood flow. Various specialized sequences optimize image acquisition. Balanced gradient echo sequences offer excellent visualization of blood and myocardium. Late gadolinium enhancement reveals fibrotic and infarcted areas. T1 and T2 mapping techniques quantify tissue abnormalities, particularly diffuse interstitial fibrosis and myocardial edema. Myocardial perfusion sequences assess cardiac ischemia by measuring blood flow into the heart muscle. Cardiac MRI is therefore a versatile tool that can explore anatomy, function, and tissue composition.

Clinical applications of cardiac MRI

Cardiac MRI is used for diagnosing and managing a wide range of cardiovascular diseases. It plays a key role in evaluating coronary artery disease and myocardial ischemia by analyzing heart muscle perfusion and infarction damage. It is also valuable in diagnosing cardiomyopathies—hypertrophic, dilated, or restrictive—by enabling fine tissue characterization. In myocarditis and other inflammatory conditions, MRI detects inflammation and edema, aiding diagnoses like viral myocarditis. It is also crucial for assessing valvular diseases and congenital heart defects, complementing echocardiography by analyzing blood flow and complex structural anomalies. Lastly, in heart transplant follow-ups, it can detect early signs of rejection by evaluating myocardial structure.

Challenges and Future Perspectives of Cardiac MRI

Despite its advantages, cardiac MRI still faces challenges that limit its widespread use. One major obstacle is the technical complexity of the exam, requiring precise acquisition protocols and expert interpretation. Exam durations can be lengthy, complicating use in patients with arrhythmias or who cannot hold their breath for long periods. Accessibility is another issue—high costs and limited availability of equipment in some hospitals hinder integration into routine clinical practice. However, technological advances, particularly in artificial intelligence (AI), are beginning to remove these barriers. AI increasingly automates image acquisition and analysis, reducing scan time and enhancing diagnostic precision. Innovations such as high-field MRI and ultra-fast acquisition sequences may also improve image quality and reduce motion artifacts.

Cardiac MRI stands out as a reference imaging modality for diagnosing and monitoring cardiovascular diseases. Offering a comprehensive view of the heart, it enables precise analysis of myocardial structure, function, and tissue composition. While technical and economic challenges still limit adoption, recent advances in AI and accelerated acquisitions suggest a future where cardiac MRI becomes more accessible and effective. Integrating this technology into routine practice is a major step toward optimizing care for patients with cardiovascular diseases.