Evolving role of cardiac magnetic resonance in cardiac amyloidosis

Cardiac amyloidosis (CA), characterized by misfolded transthyretin (ATTR) or immunoglobulin amyloid light-chain (AL) proteins, has shifted from a rarely diagnosed, near fatal or fatal condition, to a recognized and treatable cause of heart failure.This transformation has been enabled in large part by advances in non-invasive multimodality imaging, with cardiac magnetic resonance (CMR) occupying a prominent diagnostic and prognostic role.Late gadolinium enhancement, native T1 and T2 mapping, and extracellular volume quantification allow detection of amyloid infiltration with high sensitivity, often before overt phenotypic expression.CMR also provides robust and reproducible prognostic information that complements biomarkers and bone-avid scintigraphy.This review summarizes the established CMR diagnostic yield, its role within contemporary diagnostic algorithms for ATTR and AL amyloidosis, the prognostic value of quantitative tissue characterization, and the expanding evidence base for using CMR to monitor response to the new generation of disease modifying therapies.It also examines emerging evidence, including artificial intelligence assisted interpretation, non-contrast diagnostic strategies, extracardiac tissue mapping, and refinement of tissue mapping thresholds, that is likely to shape CMR practice in amyloidosis over the coming years.