Cardiac ECV mapping: Underlying concepts and clinical applications

Myocardial Extracellular volume fraction (ECV) mapping, based on cardiac magnetic resonance (CMR), is a crucial technique for assessing myocardial histological changes by evaluating extracellular matrix expansion. In recent years, cardiac ECV mapping has gained significant attention in both basic research and clinical settings, particularly for its role in myocardial fibrosis and other cardiovascular diseases. This review explores the measurement of ECV mapping, its diagnostic and prognostic value in ischemic and non-ischemic cardiovascular diseases, and emerging advancements in ECV mapping techniques. • Elaborates on the significance of ECV in assessing myocardial tissue characteristics; ECV is a crucial biomarker for evaluating myocardial fibrosis. • Analyzes the diagnostic and prognostic values of ECV in ischemic and non-ischemic cardiomyopathies, offering a basis for clinical practice. • Compares the advantages and disadvantages of CT and CMR in measuring ECV, indicating the potential of CT - ECV in assessing some diseases. • Explores the future trends of ECV. Deep-learning algorithms can enable automated measurement, and virtual ECV holds great promise.