Myocardial tissue characterization has become a central component of modern cardiovascular imaging, enabling early disease recognition, more refined differential diagnoses, and earlier prognostic assessment. The non-invasive identification of fibrosis, edema, infiltration, and perfusion abnormalities provides essential information across a broad spectrum of cardiac disorders, including ischemic heart disease, cardiomyopathies, myocarditis, and infiltrative conditions.
For many years, cardiac magnetic resonance (CMR) has been considered the gold standard for myocardial tissue characterization owing to the robustness of late gadolinium enhancement (LGE) in evaluating both ischemic and non-ischemic myocardial injuries. More recently, the development of T1 and T2 mapping techniques—and consequently the ability to estimate extracellular volume (ECV) non-invasively [1−3]—has led to a more sophisticated differential diagnosis, finer prognostic stratification, and improved treatment monitoring based on objective and quantitative biomarkers. Together, these tools offer excellent diagnostic accuracy, demonstrating high levels of sensitivity and specificity across a variety of myocardial diseases, supported by strong contemporary evidence [4−6].