Sustainable Low-Field Cardiovascular Magnetic Resonance in Changing Healthcare Systems-An Update

Cardiovascular magnetic resonance (CMR) is the gold standard imaging modality for evaluating cardiac structure, function, and myocardial tissue characteristics, yet its widespread adoption remains limited by cost, technological complexity, and infrastructure barriers-especially in low- and middle-income countries (LMICs). Recent advances in low-field (LF) CMR, particularly around 0.55 Tesla, demonstrate that strong diagnostic performance can be achieved despite reduced signal-to-noise ratios. Optimized hardware, including advanced gradient coils and radiofrequency systems, as well as AI-driven image reconstruction techniques, has greatly enhanced image quality. LF magnets offer notable advantages that reduce infrastructure demands and simplify protocols-both critical for lower resource settings. Clinical applications in cardiac function, tissue characterization, flow quantification, and even interventional procedures have expanded through sequences adapted to LFs, including novel approaches to myocardial mapping and real-time imaging. Concurrently, cryogen-free magnet designs and smaller system footprints have simplified installation and lowered operational costs. These developments bolster the feasibility of scaling CMR in environments where high-field scanners are prohibitively expensive or challenging to maintain. Moreover, greater accessibility to LF CMR could help bridge global disparities in cardiovascular diagnostics, enabling earlier detection of cardiomyopathies and ischemic heart disease in underserved regions. Although challenges remain-such as reduced signal-to-noise ratio, slower acquisition times, and limited availability of cardiac-specific hardware-ongoing innovations and collaborative global initiatives position LF CMR as a transformative, sustainable solution for modern cardiovascular care worldwide.