Left ventricular (LV) thickening can be due to hypertrophy (concentric, asymmetric, eccentric) or remodelling (concentric or asymmetric). Pathological thickening may be caused by pressure overload, volume overload, infiltrative disorders, hypertrophic cardiomyopathy, athlete’s heart or neoplastic infiltration. Magnetic resonance imaging (MRI) plays an important role in the comprehensive evaluation of LV thickening, including: establishing diagnosis, determining LV geometry, establishing aetiology, quantification, identifying prognostic factors, serial follow-up and treatment response. In this article, we review the aetiologies and pathophysiology of LV thickening, and demonstrate the comprehensive role of MRI in the evaluation of LV thickening.Teaching Points• MRI plays an important role in the evaluation of LV thickening.• LV thickening can be due to either hypertrophy or remodelling.• Pathological thickening can be due to pressure/volume overload or infiltrative disorders.Electronic supplementary materialThe online version of this article (doi:10.1007/s13244-017-0549-2) contains supplementary material, which is available to authorized users.