[Cardiovascular magnetic resonance imaging: routine use in cardiology and unique strengths]

Cardiovascular magnetic resonance (CMR) has evolved over the past two decades into a central component of modern cardiology diagnostics. Its particular strength lies in the unique combination of highly accurate functional assessment and non-invasive tissue characterization within a single examination. The indications for CMR in contemporary clinical practice are broad. In the evaluation of coronary artery disease, stress perfusion CMR enables reliable assessment of myocardial ischemia and complements this with simultaneous viability analysis using late gadolinium enhancement (LGE). In inflammatory myocardial diseases, CMR, based on the Lake Louise criteria, allows differentiation between acute and chronic injury and supports therapeutic decision-making. In the assessment of unexplained left ventricular hypertrophy, CMR provides decisive insights for differential diagnosis through mapping techniques and characteristic tissue patterns, for example in amyloidosis or hypertrophic cardiomyopathy. It also plays a key role in heart failure by contributing to etiological clarification and prognostic assessment. Additional important applications include genetic and arrhythmogenic cardiomyopathies, where CMR enables detailed evaluation of morphology, biventricular function, and fibrofatty myocardial remodeling, as well as valvular heart disease, where it allows precise quantification of regurgitant volumes, flow, and ventricular volumes, particularly when echocardiography is limited. Further indications include cardiac masses, congenital heart disease, and transplant cardiology. Overall, CMR provides an integrated, precise, and non-invasive diagnostic approach that reduces diagnostic uncertainty, improves risk stratification, and supports clinical decision-making. Future developments, particularly in quantitative imaging, standardization, and the generation of robust clinical evidence, are expected to further strengthen its role in clinical care. This article follows an indication-based approach and provides practical guidance on clinical scenarios in which CMR should be considered.