Cardiac Magnetic Resonance Imaging in Asia: 2025 Status Update

Abstract

Objective

To evaluate the current status of cardiac magnetic resonance imaging (CMR) practice across Asian regions, guiding future clinical advancements and academic collaboration in CMR.

Materials and Methods

This descriptive, cross-sectional study is based on presentations from the “Current Status of CMR in Asia” session at the 2025 Asian Society of Cardiovascular Imaging congress held on June 14. Data from nine Asian regions—including China (Mainland), Chinese Taipei, Hong Kong (China), India, Indonesia, Japan, South Korea, Thailand, and Vietnam (listed in alphabetical order)—were collected via structured surveys or general overviews, addressing institutional characteristics, technical infrastructure, clinical applications, and research activity. Descriptive statistics were used for analysis.

Results

CMR scan volumes varied widely across Asia, with high-volume centers reporting from fewer than 100 scans per month to over 20,000 scans per year. Cardiomyopathy and ischemic heart disease were the most common clinical indications, while congenital heart disease or heart failure were also important in some regions. CMR supervision differed by region, with procedures overseen by either radiologists or cardiologists. Key barriers to clinical utilization included high costs, limited scanner availability, and a shortage of trained personnel. Common research obstacles included low scan volumes, inadequate funding, and the absence of multicenter networks.

Conclusion

This study highlights the need for coordinated efforts to improve scanner access, enhance workforce training, and foster multiregional collaboration to ensure the sustainable growth of CMR practice and research across Asia.

INTRODUCTION

Cardiac magnetic resonance imaging (CMR) is a vital non-invasive imaging modality for diagnosing and managing cardiovascular diseases [1,2,3,4,5,6,7]. While its global adoption varies, CMR has seen significant expansion in Asia since the late 1980s [8].

Despite the high prevalence and burden of cardiovascular diseases in Asia [9,10], the availability and utilization of CMR remain inconsistent, highlighting the need for regional data to guide effective implementation and foster academic growth. Although global studies on CMR utilization have been published [11,12,13], data on the current status of CMR practice and research in the diverse healthcare settings across Asian countries remain sparse.

To address this gap, a multi-country initiative was conducted in conjunction with the 2025 Asian Society of Cardiovascular Imaging (ASCI) congress. During a dedicated session, titled “Current Status of CMR in Asia,” participating regions presented updates on local CMR practices through structured surveys, institutional reports, or expert opinions.

This study presents data on CMR practice and research activity across Asia. By providing a comprehensive view of the current CMR status across the region, this study aims to inform future clinical development and academic collaboration in Asia.

MATERIALS AND METHODS

This descriptive, cross-sectional study draws on presentations made during the “Current Status of CMR in Asia” session at the ASCI congress held on June 14, 2025. Nine Asian regions provided updates on CMR practice, infrastructure, and research activity through structured surveys, institutional reports, or expert-based reports.

Survey Instrument and Implementation

A suggested survey template was developed and distributed to participating countries as a non-binding guideline. It addressed key domains, including respondent and institutional characteristics, CMR availability, utilization, advanced imaging techniques, and research activity. Countries were encouraged to adapt the template or employ alternative methods for data reporting. Consequently, the reporting approaches varied among the participating regions. Six regions (China [Mainland], Chinese Taipei, Indonesia, Japan, South Korea, and Vietnam) utilized structured survey data, with China (Mainland) presenting findings from a previously published national study [8]. The remaining regions (Hong Kong [China], India, and Thailand) provided general overviews based on institutional data or expert perspectives.

Data Collection and Analysis

Descriptive summaries were employed to compare trends across regions. Owing to differences in response formats and data granularity, direct statistical comparisons between regions were not conducted.

RESULTS

CMR Utilization and Research Across Asian Regions

Table 1 summarizes the CMR volume, utilization patterns, supervision, and barriers across participating Asian regions. CMR utilization varied significantly across Asia, with high-volume centers reporting from fewer than 100 scans per month to more than 20,000 scans per year. Radiologists primarily supervised CMR in China (Mainland), Chinese Taipei, Hong Kong (China), India, and South Korea, while cardiologists predominantly oversaw CMR in Indonesia and Thailand. Cardiomyopathy and ischemic heart disease were the most common indications across regions. Additionally, some countries reported congenital heart disease (e.g., Chinese Taipei, Hong Kong [China], and Thailand) or heart failure (e.g., Japan and Thailand).

Table 1. Overview of presented CMR status across Asian regions.

Region	Data acquisition*	Largest volume†	Main supervisor	Main indications	Barriers to clinical utilization and research activity
China (Mainland) [8]	Survey (248)	20,000/year	Radiologist	Cardiomyopathy, coronary artery disease	Profound disparities across centers, shortage of post-processing software, long scan time, high costs, insufficient equipment, limited training
Chinese Taipei	Survey (30)	51–100/month	Radiologist	Cardiomyopathy, congenital heart disease	Clinical: lack of trained specialist, limited availability of MRI scanners Research: low CMR scan volume or difficulty recruiting patients for studies
Hong Kong (China)	From Queen Mary Hospital	15/week	Radiologist	Ischemic heart disease, grown-up congenital heart disease, cardiomyopathy	Limited time slots, lack of specialized expertise in cardiac imaging
India	Anecdote-based overview	3,500/year	Radiologist	Ischemic heart disease, cardiomyopathy	Relatively low profitability, long scan time, high cost of post-processing software
Indonesia	Survey (21‡)	>100/month	Cardiologist	Ischemic heart disease, cardiomyopathy, arrhythmia	Clinical: high cost for patients or lack of insurance coverage Research: limited funding for CMR research
Japan	Survey (9)	NA	NA	Heart failure, ischemic heart disease	NA
South Korea	Survey (27)	>100/month	Radiologist	Cardiomyopathy, ischemic heart disease	Clinical: high cost for patients Research: low CMR scan volume or difficulty recruiting patients for studies
Thailand	Personal professional contacts	>1,000/year	Cardiologist	Ischemic heart disease, cardiomyopathy, heart failure, and congenital heart disease	Clinical: no national guideline, limited resources outside Bangkok, long waiting list, lack of CMR-physicists Research: no national registry, clinical scanning > research scanning
Vietnam	Survey (3)	85/month	NA	Cardiomyopathy	Clinical: long waiting time, limited availability of MRI scanners Research: limited availability of research-dedicated MRI time slots, limited funding for CMR research

^*Numbers in parentheses are the numbers of hospitals participated in the survey, unless otherwise specified, ^†Largest volume refers to the estimated number of CMR examinations performed at the single highest-volume hospital in each country, ^‡The number of respondents participated in the survey.

CMR = cardiac magnetic resonance imaging, NA = not available

China (Mainland)

A recent nationwide study in China (Mainland), based on survey data from 248 hospitals, described the current status of CMR [8]. The median annual CMR volume was 120 cases per center, while Fuwai Hospital conducted 20,000 CMR examinations in 2024. The study highlighted the uneven distribution of scanners and emphasized that reducing costs and improving training are essential for balanced development.

Chinese Taipei

In Chinese Taipei, national health insurance covers most CMR examinations, excluding stress perfusion. However, a shortage of specialists and limited scanner availability continue to pose barriers to CMR utilization. Consequently, difficulties in recruiting patients remain a major research hurdle.

Hong Kong (China)

In Hong Kong (China), CMR scanner availability is limited, with dedicated cardiac slots available only on select days. Radiologists must cover all imaging areas while maintaining a special focus on cardiac studies, despite the small size of academic radiology, which is supported by only two medical schools. This underscores the need for a formal cardiac imaging subspecialty.

India

Cardiovascular disease is highly prevalent in India and remains the leading cause of mortality. However, there is a significant disparity in CMR service provision across the country. While a few centers of excellence perform CMR routinely and at high volumes, most centers conduct fewer than 5–10 studies per month. MRI scanner slots are often prioritized for more profitable examinations, such as lumbar spine or brain studies, which can generate nearly twice the revenue of a typical CMR exam. The resulting low CMR volume limits technologists’ experience, contributing to prolonged scan times and reduced efficiency. Additionally, the high cost of post-processing software remains a major barrier, preventing many institutions from offering CMR despite clinical demand.

Indonesia

CMR was introduced in Indonesia at the National Cardiovascular Center Harapan Kita in 2011, followed by the establishment of a fellowship training program in 2013. Cardiologists serve as the primary CMR managers in most Indonesian centers. The cost of CMR examinations exceeds 500 US dollars and varies based on government reimbursement schemes; high costs and the lack of universal insurance coverage limit their broader utilization. CMR research is further limited by insufficient funding. Indonesia’s future priorities emphasize the need for more equitable access to CMR services nationwide and fostering multicenter research networks.

Japan

In Japan, CMR utilization remains lower than other cardiac imaging modalities, such as computed tomography and coronary angiography, but it has been steadily increasing at approximately 12.8% per year. With a growing older population, hospital admissions and in-hospital mortality due to heart failure have surpassed those for acute myocardial infarction. In response, academic centers are increasingly incorporating parametric mapping to enhance heart failure assessment.

South Korea

In South Korea, a nationwide survey of 36 radiologists from 27 hospitals provided a comprehensive overview of CMR practice. Proportional data on training level and perceived primary barriers were reported per respondent (n = 36), while all other percentages were calculated per institution (n = 27). Most respondents (30/36, 83.3%) were either experts with ≥5 years of post-fellowship experience or had completed a domestic CMR fellowship, indicating a high level of expertise. The institutions were predominantly large (with ≥500 beds, 26/27, 96.3%), academic or research centers (23/27, 85.2%), located in metropolitan areas (15/27, 55.6%), reflecting a concentration of resources. All surveyed centers reported radiologists as the primary supervisors of CMR.

CMR was well integrated into clinical practice, with 85.2% (23/27) of hospitals reporting routine clinical use. However, over half of the hospitals (14/27, 51.9%) had a monthly CMR volume of fewer than 10 cases. The most common clinical indication was cardiomyopathy (23/27, 85.2%). The primary barriers to clinical utilization were high cost or lack of insurance coverage (17/36, 47.2%), followed by scanner availability (7/36, 19.4%). Tissue characterization techniques were widely available, with T1 mapping in 85.2% (23/27) of hospitals and T2 mapping in 81.5% (22/27). However, the use of other advanced techniques was relatively limited.

Research activity was modest: 37.0% (10/27) of hospitals had published original CMR research, and 22.2% reported ongoing prospective trials. Participation in CMR registries was rare (2/27, 7.4%). Major research barriers included difficulty recruiting patients because of low scan volume (15/36, 41.7%), lack of research expertise (7/36, 19.4%), and limited funding (6/36, 16.7%). A complete summary of the survey findings is provided in Supplementary Table 1.

Thailand

Since its introduction by cardiologists in 2001, CMR in Thailand has been primarily managed by cardiologists in most hospitals. A one-year fellowship training program provides hospital-level certification in CMR, but there is no national accreditation. The lack of a national registry or formal guidelines, coupled with limited resources outside Bangkok, remains a significant challenge.

Vietnam

Vietnam identified long waiting times as an obstacle, with an estimated waiting period of 1–3 days for both inpatient and outpatient cases. Future perspectives suggest increasing the number of CMR scanners to reduce patient waiting times. Regarding research limitations, a shortage of research-dedicated MRI time slots and limited funding were reported.

DISCUSSION

This study provides the first cross-sectional overview of CMR practice across Asia, highlighting substantial variation in utilization patterns, infrastructure, and supervising specialties. Despite regional differences, several shared challenges were identified, including limited scanner availability, a shortage of trained personnel, and low research capacity. These findings underscore the need to expand access, strengthen specialist training, and support sustainable research infrastructure across the region.

Aging populations and the increasing burden of heart disease may drive future demand for broader CMR utilization and adoption of advanced techniques across Asia [10,14,15,16,17,18,19,20,21]. CMR activity in Asia appears to have emerged in the late 1980s to early 1990s [8,22,23,24], following its earlier introduction in Western countries [25]. Since then, CMR practice has steadily expanded across the continent, although disparities in access, expertise, and institutional support remain pronounced.

The common barriers to CMR adoption fall into three categories: infrastructure and resources, economics and policy, and workforce and expertise. Infrastructural challenges include limited scanner availability and long waiting times, restricting patient access. High procedure costs and limited reimbursement hinder patient access, while low profitability reduces hospitals’ incentives to invest in CMR services. The high cost of post-processing software limits the full utilization of imaging data. Workforce challenges, such as a shortage of trained personnel and the absence of national guidelines or subspecialty programs, compromise the quality and consistency of CMR practice.

These challenges contribute to significant regional disparities in CMR practice, not only between countries but also within nations. The concentration of CMR resources and trained personnel in metropolitan areas and large hospitals is common across Asian regions, including South Korea, China (Mainland), and Thailand. This unequal distribution of resources directly impacts patient access, creating a gap in cardiovascular care between urban and rural populations. Addressing this disparity requires a strategic approach to ensure a more balanced and equitable distribution of CMR infrastructure and expertise.

Despite the growing clinical adoption of CMR across Asia, research capacity remains a significant challenge. For instance, while CMR is well integrated into routine clinical care in South Korea, supported by experienced personnel and robust technological infrastructure [26,27,28], research activity remains modest. Recent investigations have explored techniques such as mapping, radiomics, deep learning, and four-dimensional flow imaging [29,30,31,32,33,34,35]; however, these advancements remain concentrated in a few centers, and multicenter or prospective designs remain scarce. Common research barriers extend beyond low scan volumes to include limited access to research-dedicated MRI time slots, insufficient funding, and the absence of national registries or coordinated research networks. These structural limitations collectively restrict the feasibility of multicenter collaboration, hindering the development of large-scale, population-specific studies.

To address these challenges, a comprehensive strategy is required. First, to overcome the economic and efficiency barriers, the adoption of abbreviated CMR protocols or fast sequences should be considered [36,37,38]. As indicated by our data on long waiting times and low profitability, these protocols can improve scanner throughput, reduce costs, and enhance the feasibility of CMR, not only in low-resource settings [39] but also in high-volume centers facing efficiency pressures. Professional societies such as the ASCI should play a central role in developing consensus or guidelines for streamlined CMR protocols.

Second, to address workforce and research capacity issues, more proactive, multiregional collaboration within the CMR expert community would be highly beneficial. This collaboration could standardize training curricula, share educational resources, and facilitate the establishment of a multinational registry. Such collaboration is essential for collective problem-solving and would enable the development of large-scale, multicenter research initiatives, which are currently hindered by low scan volumes and fragmented resources, as evidenced by experiences in Western countries [40].

This study had several limitations. First, it included a limited number of Asian regions and may not fully represent the diversity of CMR practice across the entire continent. Second, differences in data collection methods across regions introduced some variability in scope and detail. Nonetheless, the multinational perspective presented here provides a rare and valuable foundation for future cooperative efforts.

In conclusion, while CMR practice in Asia continues to grow, its full potential is constrained by key challenges, including limited access, workforce shortages, and insufficient research support, all of which are compounded by significant regional disparities. A comprehensive strategy, including improved efficiency and stronger collaborative frameworks, is essential for the continued development of CMR across the region.

Supplement

The Supplement is available with this article at https://doi.org/10.3348/kjr.2025.1214.