Review ArticleCardiac Magnetic Resonance Tissue Characterization in Ischemic CardiomyopathyMuscogiuri, Giuseppe MD, PhD*; Ricci, Francesca MD*; Scafuri, Stefano MD*; Guglielmo, Marco MD*; Baggiano, Andrea MD*; De Stasio, Vincenzo MD†; Di Donna, Carlo MD†; Spiritigliozzi, Luigi MD†; Chiocchi, Marcello MD†; Lee, Scott J. MD‡; De Cecco, Carlo N. MD, PhD‡; van Assen, Marly MSc, PhD‡; Rabbat, Mark G. MD§,∥; Pontone, Gianluca MD, PhD, FESC, FSCCT* Author Information *Cardiological Center Monzino, IRCCS, Milano †Division of Diagnostic Imaging, Department of Biomedicine and Prevention, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Rome, Italy ‡Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA §Loyola University of Chicago, Chicago ∥Edward Hines Jr. VA Hospital, Hines, IL G.M. and F.R. contributed equally. The authors declare no conflicts of interest. Correspondence to: Gianluca Pontone, MD, PhD, FESC, FSCCT, Via C. Parea 4, Milan 20138, Italy (e-mail: [email protected]). Journal of Thoracic Imaging 37(1):p 2-16, January 2022. | DOI: 10.1097/RTI.0000000000000621 Buy Metrics Abstract Ischemic cardiomyopathy (ICM) is one of the most common causes of congestive heart failure. In patients with ICM, tissue characterization with cardiac magnetic resonance imaging (CMR) allows for evaluation of myocardial abnormalities in acute and chronic settings. Myocardial edema, microvascular obstruction (MVO), intracardiac thrombus, intramyocardial hemorrhage, and late gadolinium enhancement of the myocardium are easily depicted using standard CMR sequences. In the acute setting, tissue characterization is mainly focused on assessment of ventricular thrombus and MVO, which are associated with poor prognosis. Conversely, in chronic ICM, it is important to depict late gadolinium enhancement and myocardial ischemia using stress perfusion sequences. Overall, with CMR’s ability to accurately characterize myocardial tissue in acute and chronic ICM, it represents a valuable diagnostic and prognostic imaging method for treatment planning. In particular, tissue characterization abnormalities in the acute setting can provide information regarding the patients that may develop major adverse cardiac event and show the presence of ventricular thrombus; in the chronic setting, evaluation of viable myocardium can be fundamental for planning myocardial revascularization. In this review, the main findings on tissue characterization are illustrated in acute and chronic settings using qualitative and quantitative tissue characterization. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.