Cardiac magnetic resonance imaging and computed tomography: state of the art in clinical practice

Recent technological innovations in CT and MR imaging of the heart have vastly expanded the clinical utility of these modalities allowing them to complement and in some ways surpass the capabilities of more traditional methods. Cardiac MR (CMR) has an unrivaled ability to assess contractile function, characterize tissue, and detect minute areas of scar. In turn, CMR can reliably risk stratify ischemic heart disease and has emerged as a non-invasive gold standard technique for imaging non-ischemic cardiomyopathies.1 Cardiac CT (CCT) by comparison reveals cardiac structure and, in particular, coronary anatomy with remarkable sub-millimeter detail. For the first time, coronary stenoses can be directly and reliably visualized non-invasively. Owing to its very high negative predictive value for the detection of significant coronary obstruction, CCT can accurately exclude coronary disease as a cause of chest pain in low- to intermediate-risk populations. This article describes these modalities and their recent clinical advances.