Clinical Applications of Cardiac Diffusion MRI: A Scoping Review

Area of Science:

• Cardiovascular Imaging
• Magnetic Resonance Imaging
• Diffusion Imaging Techniques

Background:

• Diffusion-weighted imaging (DWI) and related techniques offer insights into myocardial microstructure.
• Cardiac MRI applications are expanding with advanced diffusion imaging methods.
• Understanding the current landscape of cardiac diffusion imaging is crucial for clinical translation.

Purpose of the Study:

• To conduct a scoping review of in vivo human studies on diffusion-weighted imaging (DWI) in cardiac MRI.
• To characterize the extent, clinical applications, and emerging trends of cardiac DWI techniques.
• To identify limitations and future directions for clinical adoption of cardiac diffusion imaging.

Main Methods:

• Systematic literature search of Ovid MEDLINE All, Embase, and Cochrane Library databases.
• Independent screening and data extraction by two reviewers on study characteristics, imaging techniques, and applications.
• Descriptive synthesis of findings due to heterogeneity; quality assessment using Newcastle-Ottawa scale.

Main Results:

• 55 studies met inclusion criteria, focusing on hypertrophic cardiomyopathy (20) and ischemic heart disease (17).
• DWI showed high sensitivity and specificity for acute myocardial infarction detection.
• Cardiac diffusion tensor imaging and intravoxel incoherent motion demonstrated potential for microstructural and microvascular assessment, though evidence in other conditions is limited.

Conclusions:

• Diffusion imaging techniques hold potential for characterizing myocardial microstructure and pathology.
• Heterogeneity in acquisition protocols, small sample sizes, and limited clinical validation hinder broader adoption.
• Further standardization and clinical validation are needed for widespread clinical translation of cardiac DWI.