Right ventricular cardiovascular magnetic resonance imaging: normal anatomy and spectrum of pathological findings

BACKGROUND: The right ventricle (RV) has been defined as the “forgotten chamber”, as its role in cardiac physiopathology has long been underestimated. Nevertheless, the RV is involved in a wide range of pathological conditions and its altered function may significantly affect the patient’s clinical status. METHODS: A selection of the most common cardiovascular magnetic resonance (CMR) features in a spectrum of pathological conditions is illustrated. Although its complex morphology, thin myocardium and trabeculated apex, RV can be accurately imaged by CMR, revealing its involvement in ischaemic and non-ischaemic heart disease. CMR has emerged as the pre-eminent modality in monitoring ventricular performance in congenital heart disease, pulmonary hypertension and cardiomyopathies. Arrhythmogenic right ventricular cardiomyopathy is a difficult diagnosis and the recently revised task force criteria confirmed a crucial role of CMR to increase diagnostic accuracy, by combining detection of RV dilation, regional wall motion and structural abnormalities. Moreover, a multiparametric approach of CMR is often necessary for delineation and characterisation of cardiac masses. CONCLUSION: CMR, combining assessment of morphology, structure and function, has definitively emerged as the reference technique to evaluate a large variety of RV diseases. TEACHING POINTS: • CMR offers unique advantages for imaging of many RV congenital, ischaemic and non-ischaemic diseases. • Because of high reproducibility, CMR has a crucial role in decision-making for chronic RV pathology. • The use of CMR increases detection of RV disease as infarction or arrhythmogenic cardiomyopathy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13244-013-0222-3) contains supplementary material, which is available to authorized users.