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Cardiac MRI (CMR): Uses, Sequences & What It Shows

Cardiac MRI of a normal heart, 4-chamber bSSFP, labelled: right ventricle, left ventricle, septum. Handwritten note: blood bright, muscle dark.
MRI: Baggiano A, Del Torto A, Guglielmo M, et al. Diagnostics 2020, Fig. 1B, CC BY 4.0, doi:10.3390/diagnostics10100770. Cropped; labels added.

Cardiac MRI (CMR): Uses, Sequences & What It Shows

The reference standard for myocardial tissue characterisation, showing how the heart moves and what the muscle is made of.

Updated September 2026 · 1 source listed

On this pageWhat CMR showsKey indicationsPractical notesSources

What CMR shows

Cardiac MRI combines several acquisitions in one study: cine imaging for function, late gadolinium enhancement (LGE) for scar, mapping for diffuse disease, and phase-contrast for flow. It is uniquely able to distinguish patterns of myocardial injury non-invasively.

  • Function & volumes: cine SSFP gives the most reproducible ejection fraction and chamber volumes, and is the gold standard for serial follow-up.
  • Viability & scar (LGE): subendocardial/transmural LGE in a coronary territory indicates infarct; the transmurality predicts recovery after revascularisation.
  • Non-ischaemic patterns: mid-wall or epicardial LGE points away from coronary disease (e.g. myocarditis, sarcoid, dilated or hypertrophic cardiomyopathy).

Key indications

QuestionWhat CMR adds
Viability before revascularisationLGE transmurality predicts functional recovery
MyocarditisOedema (T2) + non-ischaemic LGE (updated Lake Louise criteria)
Cardiomyopathy workupPhenotype + fibrosis pattern; risk stratification
Infiltration / storageT1/ECV (amyloid, fibrosis), T2* (iron overload)
Congenital / valve / shuntPhase-contrast flow, Qp:Qs quantification
Mapping matters: native T1 and ECV detect diffuse disease invisible to LGE; T2* quantifies myocardial iron and guides chelation in thalassaemia.

Practical notes

CMR needs breath-holds and ECG gating, so rhythm and cooperation affect quality. Gadolinium is used for LGE; check renal function. For device patients, confirm MR-conditional status. See the Implant Safety Checker.

Sources

  1. Ferreira VM et al. Cardiac MRI in myocardial inflammation: expert recommendations (updated Lake Louise Criteria). J Am Coll Cardiol 2018;72:3158–76. Messroghli DR et al. JCMR 2017;19:75.

Educational summary for clinicians; indications and protocols vary by centre and guideline. Not medical advice.

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Educational reference for imaging professionals. It does not replace local policy, manufacturer labelling or clinical judgement.

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