Beyond volumes and ejection fraction: practical insights into cine-CMR interpretation and applications

Cine cardiovascular magnetic resonance (cine-CMR) is a fundamental imaging technique for the evaluation of cardiac morphology and function. As the gold standard for chamber quantification, it enables precise and reproducible assessment of atrial and ventricular volumes, myocardial mass, and ejection fraction. In addition to conventional parameters, cine-CMR supports advanced functional analysis through myocardial strain and mechanical dispersion, allowing early identification of subclinical dysfunction and characterization of mechanical dyssynchrony. The technique also provides surrogate markers for diastolic function, such as left atrial strain and time-volume curve analysis. Cine-CMR proves valuable across a broad spectrum of clinical scenarios, including pediatric cardiology, congenital heart disease, athlete's heart evaluation, and functionally univentricular physiology. Methodological factors-including segmentation strategies, phase selection, and indexing approaches-can influence measurements and must be aligned with validated reference standards to ensure consistency. Furthermore, cine-CMR extends its utility to the qualitative assessment of valvular disease, pericardial abnormalities, and cardiac masses. This review offers a practical and comprehensive overview of the clinical applications, technical considerations, and interpretative strategies for cine-CMR, aiming to support its optimal use in routine cardiovascular practice.