Cardiac MRI in Depiction of Myocardial Edema: A Comprehensive Review

The term myocardial edema refers to abnormal myocardial fluid accumulation due to impaired fluid homeostasis, triggered by a complex interplay of cellular, molecular, and hemodynamic factors. It is a multifaceted pathologic phenomenon with diverse clinical manifestations and plays a pivotal role in the pathophysiology of various cardiovascular conditions, such as ischemic, inflammatory, infiltrative, toxic, infectious, and autoimmune diseases. Detection of myocardial edema presents some challenges, necessitating familiarity with imaging strategies and potential artifacts, differential diagnoses of myocardial edema-associated conditions, and the clinical implications for risk stratification. Cardiac MRI is a key tool in evaluation of myocardial edema, often providing critical insights into underlying disease processes and aiding in clinical decision making. It is not only useful for detailed tissue characterization but also plays a significant role in monitoring diseases. T2-weighted imaging and T2 mapping are essential for identifying myocardial edema, while other techniques such as cine imaging, T1 mapping, and late gadolinium enhancement imaging can provide complementary characterization. Although cardiac MRI is indispensable for edema evaluation, understanding its capabilities and limitations is essential for accurate assessment. Recognizing different edema patterns and integrating findings with the clinical context are fundamental to the diagnostic process. The authors examine the diagnostic utility of cardiac MRI in characterizing myocardial edema through various case examples and a comprehensive review of the existing literature. By addressing the role of myocardial edema in a range of cardiovascular conditions, they provide a systematic framework outlining key aspects of edema imaging. ^©RSNA, 2026 Supplemental material is available for this article.