Cardiovascular Magnetic Resonance (CMR) CMR is a new technique for investigating the heart that combines the important attributes of safety, high resolution, versatility and excellent image quality. Whilst some aspects of CMR are in development, others are truly established in the clinical arena. Leading referrals are not only in coronary artery disease (ventricular function and viability), cardiomyopathy (aetiology and progression), vascular disease (angiography) and congenital disease (anatomy and function) but also in a wide range of other pathologies. CMR is the safe cardiovascular imaging technique of the future, which is available now. Case Study A 30 year old man suffered chest pain, and an ambulance was called. On arrival he had a ventricular fibrillation (VF) arrest, was cardioverted and brought into hospital. Cardiac enzymes and Troponin I were normal, as were the coronary arteries by angiography and wall motion by echocardiography. Referral for CMR was made to determine a diagnosis, and primarily to exclude arrhythmogenic right ventricular cardiomyopathy (ARVC). CMR showed normal left ventricular volumes and function, and the right ventricle was also normal with no signs of ARVC. Infarct CMR was then performed using the late enhancement gadolinium technique. This showed a small infarction in the anterior wall of just 0.5 mm of myocardium. The diagnosis of VF arrest secondary to infarction was made. Only the high resolution of CMR was able to confidently make the correct diagnosis that prevented diagnostic uncertainty and the potential for unnecessary further investigation and inappropriate therapy.   Figure 1| shows the infarct CMR technique using gadolinium. There is a small subendocardial infarction (MI) in the anterior wall (black arrow). Figure 2| shows a turbo spin echo image, clearly showing patency of the left anterior descending (LAD) and posterior descending arteries (PDA), and normal myocardial anatomy and texture of the right (RV) and left ventricular (LV) myocardium. Figure 3: Shows 2 frames from a trueFISP cine, in diastole and systole. There is no contraction abnormality associated with the infarction because of its small size. Qualification of LV and RV volumes was normal. All images are in the same plane, showing how CMR can apply multiple different sequences in an area of pathology to determine a diagnosis. print this case study