Evolving role of cardiac magnetic resonance in cardiac amyloidosis

Table 1 Core cardiac magnetic resonance imaging tissue characterization parameters in cardiac amyloidosis

Parameter	Normal range	Cardiac amyloidosis	Clinical utility	Ref.	Strength of supporting evidence
Native T1 (1.5T)	Approximately 950-1000 ms	Markedly elevated, often > 1100-1150 ms	Among the highest sensitivity/specificity of any CMR marker; rises before LGE in early disease	[7,12]	Moderate-High, multiple concordant cohort studies and meta-analyses
Native T1 (3T)	Approximately 1200-1300 ms	Markedly elevated, often > 1300-1400 ms	Same diagnostic role; absolute thresholds are field-strength and sequence dependent	[7,12]	Moderate-High, multiple concordant cohort studies and meta-analyses
ECV	Approximately 25%-28%	Frequently > 40%, can exceed 50%-60%	Strongest single prognostic CMR parameter; tracks amyloid burden and treatment response	[8,9,11]	High, consistently the strongest single prognostic/diagnostic parameter across multiple meta-analyses
LGE pattern	Absent	Diffuse subendocardial → transmural; atrial, RV, valvular involvement	Historic diagnostic anchor; correlates with disease stage and biomarkers	[2,3,15]	High, long established diagnostic anchor across large cohorts
Native myocardial T2	Normal	Usually normal to mildly elevated unless acute decompensation	Helps exclude active myocarditis/edema as an LVH mimic	[13]	Low-Moderate, smaller, more heterogeneous evidence base, primarily single/few-centre studies

Normal and disease-range values shown are representative of published cohorts; absolute thresholds vary by scanner vendor, field strength, and mapping sequence and should be interpreted against each site’s local reference ranges. CMR: Cardiac magnetic resonance; LGE: Late gadolinium enhancement; ECV: Extracellular volume; RV: Right ventricle; LVH: Left ventricular hypertrophy.