Cardiovascular disease is the leading cause of death and a significant contributor of health care costs. Noninvasive imaging plays an essential role in the management of patients with cardiovascular disease. Cardiac magnetic resonance (MR) can noninvasively assess heart and vascular abnormalities, including biventricular structure/function, blood hemodynamics, myocardial tissue composition, microstructure, perfusion, metabolism, coronary microvascular function, and aortic distensibility/stiffness. Its ability to characterize myocardial tissue composition is unique among alternative imaging modalities in cardiovascular disease. Significant growth in cardiac MR utilization, particularly in Europe in the last decade, has laid the necessary clinical groundwork to position cardiac MR as an important imaging modality in the workup of patients with cardiovascular disease. Although lack of availability, limited training, physician hesitation, and reimbursement issues have hampered widespread clinical adoption of cardiac MR in the United States, growing clinical evidence will ultimately overcome these challenges. Advances in cardiac MR techniques, particularly faster image acquisition, quantitative myocardial tissue characterization, and image analysis have been critical to its growth. In this review article, we discuss recent advances in established and emerging cardiac MR techniques that are expected to strengthen its capability in managing patients with cardiovascular disease. Level of Evidence: 5 Technical Efficacy: Stage 1

MRI at high and ultra high field strengths suffers from B1+ inhomogeneities, but B1+ shimming with multiple transmit coils is only available at top-line scanners. Dielectric pads allow for localized B1+ changes, but need to be specifically designed for the scan and anatomy. In this work we explore the use of an actively switchable dielectric device to allow for spatial B1+ correction without the need for multiple transmit coils. Our phantom experiments at 3T show that coupling mini-pockets with barium titanate slurry enables various field configurations that are switchable, localized and significant in magnitude.

Acoustic noise in MRI is a main source of patient anxiety, with noise levels reaching up to 130 dB. In this work, a low-cost solution is proposed, combining active noise cancelling and direct sequence noise prediction from the scanner gradient inputs. The prediction is based on the linearity between gradient coil input derivative and corresponding acoustic noise. A proposed Predictive Noise Cancelling demonstrated an in-bore noise reduction up to 10 dB despite the system imperfections.