MR imaging of coronary arteries and plaques

Imaging the coronary arteries without radiation or contrast dye is a long-standing aspiration. This review assesses how close cardiac MRI has come — and how far it still has to go.

The appeal is clear: MRI could characterize coronary arteries and the plaque within them non-invasively and without ionizing radiation, potentially adding tissue detail that CT and invasive angiography don’t. The authors are frank that the promise is largely unrealized — the coronary arteries are small, fast-moving targets, and the technical and standardization hurdles keep MRI coronary imaging from routine clinical use.

The practical takeaway is to watch this space rather than act on it: a radiation-free, multiparametric coronary exam would be valuable, but it isn’t ready. The resistance, when it arrives, will come from workflows and expertise built around CT and invasive angiography.

We rate the evidence moderate: a narrative review from leading experts, foundation-funded (low commercial conflict), summarizing the state of an emerging technique. Its clinical significance is moderate and potential — transformative if the technical barriers fall, but not yet a tool that changes care.