Advances in non-contrast coronary magnetic resonance angiography

Coronary artery disease (CAD) remains a major cause of morbidity and mortality worldwide, and accurate coronary imaging is essential for early diagnosis, risk stratification, treatment planning, and longitudinal follow-up. Non-contrast coronary magnetic resonance angiography (CMRA) is a non-invasive, radiation-free imaging technique that enables visualization of the coronary arteries without the use of exogenous contrast agents. Compared with coronary computed tomography angiography (CCTA) and invasive coronary angiography, non-contrast CMRA offers potential advantages in patients requiring repeated examinations, those with contraindications to iodinated contrast agents, and individuals with severe coronary calcification. However, its broader clinical adoption has been limited by relatively low spatial resolution, prolonged acquisition time, complex scan planning, and sensitivity to cardiac and respiratory motion. Recent advances in magnetic field strength, sequence design, motion compensation, accelerated acquisition, and deep learning-based reconstruction have substantially improved the image quality, acquisition efficiency, and clinical feasibility of non-contrast CMRA. This review summarizes recent progress in non-contrast CMRA, focusing on magnetic field strength, commonly used imaging sequences, nitrate administration, acquisition and reconstruction strategies, clinical applications, and field strength–dependent sequence implementation. Current limitations and future directions are also discussed, with the aim of providing insights for technical optimization, standardized protocols, and broader clinical translation.