Table 1.

Cardiovascular magnetic resonance techniques to assess myocardial fibrosis valvular heart disease

CMR technique	Availability	Fibrosis specificity	Advantages	Limitations	Experience in VHD
T1 mapping (native T1 and ECV quantification)	++	+++	Assessment of diffuse fibrosis, early disease changes (preclinical stages). Quantification of the degree of fibrosis	Multiple methodologies, no standardized reference values, overlap between normal and diseased myocardium	++
Late gadolinium enhancement	+++	+++	Reference standard for assessment of replacement fibrosis	Focal fibrosis assessment only	+++
Molecular imaging	±	++++	Improved visualization of fibrosis, investigation of underlying processes (necrosis, apoptosis, inflammation, scar maturation…)	Experimental technique, animal studies only	–
CMR tagging	++	+	Current gold standard for myocardial deformation assessment, high reproducibility of the results	Expertise, additional scan sequences, time consuming post-processing, tag fading through cardiac cycle (only with some techniques), limited in assessment of thin myocardium	++
Feature tracking CMR	+++	+	Post-processing of SSFP cines (no additional scan sequences), relatively fast post-processing, high feasibility	Susceptible to through-plane motion artifacts, limited inter-vendor agreement	+

CMR cardiovascular magnetic resonance, ECV extracellular volume, SSFP steady state free precession, VHD valvular heart disease