Clinical translation of three-dimensional scar, diffusion tensor imaging, four-dimensional flow, and quantitative perfusion in cardiac MRI: A comprehensive review

Sophie Paddock, Vasiliki Tsampasian, Hosamadin Assadi, Bruno Calife Mota, Andrew J. Swift, Amrit Chowdhary, Peter Swoboda, Eylem Levelt, Eva Sammut, Amardeep Dastidar, Jordi Broncano Cabrero, Javier Royuela Del Val, Paul Malcolm, Julia Sun, Alisdair Ryding, Chris Sawh, Richard Greenwood, David Hewson, Vassilios Vassiliou, Pankaj Garg

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Cardiovascular magnetic resonance (CMR) imaging is a versatile tool that has established itself as the reference method for functional assessment and tissue characterisation. CMR helps to diagnose, monitor disease course and sub-phenotype disease states. Several emerging CMR methods have the potential to offer a personalised medicine approach to treatment. CMR tissue characterisation is used to assess myocardial oedema, inflammation or thrombus in various disease conditions. CMR derived scar maps have the potential to inform ablation therapy—both in atrial and ventricular arrhythmias. Quantitative CMR is pushing boundaries with motion corrections in tissue characterisation and first-pass perfusion. Advanced tissue characterisation by imaging the myocardial fibre orientation using diffusion tensor imaging (DTI), has also demonstrated novel insights in patients with cardiomyopathies. Enhanced flow assessment using four-dimensional flow (4D flow) CMR, where time is the fourth dimension, allows quantification of transvalvular flow to a high degree of accuracy for all four-valves within the same cardiac cycle. This review discusses these emerging methods and others in detail and gives the reader a foresight of how CMR will evolve into a powerful clinical tool in offering a precision medicine approach to treatment, diagnosis, and detection of disease.
Original languageEnglish
Article number682027
JournalFrontiers in Cardiovascular Medicine
Publication statusPublished - 7 Jul 2021


  • cardiovascular magnetic resonance
  • diffusion tensor imaging
  • four-dimensional flow imaging
  • myocardial fibrosis
  • tissue characterisation

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