Noninvasive imaging of myocardial extracellular matrix for assessment of fibrosisWon, Samuela,b; Davies-Venn, Cynthiaa,b; Liu, Songtaoa,b; Bluemke, David A.a,bCurrent Opinion in Cardiology: May 2013 - Volume 28 - Issue 3 - p 282–289 doi: 10.1097/HCO.0b013e32835f5a2b MOLECULAR GENETICS: Edited by Ali J. Marian Abstract Author Information Purpose of review Myocardial fibrosis is a common feature of many cardiomyopathies, including hypertrophic cardiomyopathy. Myocardial fibrosis has been shown to be reversible and treatable with timely intervention. Although early detection and assessment of fibrosis is crucial, adequate diagnostics are still in development. Recent studies have shown progress on noninvasive imaging methods of fibrosis using cardiovascular magnetic resonance (CMR) and nuclear imaging modalities. Recent findings T1 mapping and extracellular volume mapping (ECV) combined with CMR imaging are cutting edge methods that have the potential to assess interstitial myocardial fibrosis. Recent findings show that ECV measurement can be correlated to the extent of diffuse fibrosis. Comparatively, molecular imaging targets specific biomarkers in the fibrosis formation pathway and provides enhanced sensitivity for imaging early disease. Biomarkers include molecules involved in angiogenesis, ventricular remodeling, and fibrotic tissue formation, whereas collagen targeted agents can directly identify fibrotic tissue in the heart. Summary This review introduces novel methods of fibrosis imaging that utilize properties of extracellular matrix and its biomarkers. Changes in characteristics and cellular biomarkers of the extracellular space can provide significant information regarding fibrosis formation and its role in cardiomyopathy. Ultimately, these findings may improve detection and monitoring of disease and improve efficiency and effectiveness of the treatment. aRadiology and Imaging Sciences, National Institutes of Health Clinical Center bMolecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland, USA Correspondence to David A. Bluemke, MD, PhD, Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive, Rm 10/ 1C355, Bethesda, MD 20892, USA. Tel: +1 301 402 1854; fax: +1 301 480 0055; e-mail: firstname.lastname@example.org © 2013 Lippincott Williams & Wilkins, Inc.