Graphical Abstract.
Myocardial fibrosis occurs when various forms of myocardial injury affect previously healthy myocardium. Various existing imaging techniques including cardiovascular magnetic resonance, computed tomography, echocardiography, and nuclear imaging (single-photon emission computed tomography and 18F-FDG PET) assess the extent and pattern of myocardium scar. However, they are not specific to fibrosis and detect established fibrosis that may no longer be modifiable with treatment. Novel molecular fibrosis imaging methods may for the first time allow highly specific imaging of fibrosis activity. Benefits over existing modalities may include detection of the earliest stages of fibrogenesis, differentiation between active and end-stage disease, assessment of response to treatment in vivo as well as determination of the anti-fibrotic potential of existing and novel agents. These new techniques remain under investigation to determine their clinical utility. CMR images of myocardial infarction courtesy of Dr Trisha Singh. 68Ga-FAPI-04 Images courtesy of Dr Zohreh Varasteh.