Before and Beyond Tissue Characterization: Cardiac Magnetic Resonance Imaging in the Morphological, Volumetric, and Functional Evaluation of the Right Ventricle in Arrhythmogenic Right Ventricular Cardiomyopathy, a Narrative Review

Arrhythmogenic right ventricular cardiomyopathy is a condition characterized by fibro-fatty replacement, primarily affecting the right ventricle (RV), with variable involvement of the left ventricle, characterized by an increased risk of ventricular arrhythmias and sudden cardiac death. In addition to tissue characterization, which is not the subject of this review, dilation, global systolic dysfunction, and regional kinetic abnormalities of the RV are important components of the diagnostic process for this disease, serving as essential diagnostic criteria. Cardiac magnetic resonance, a central examination in the evaluation of cardiomyopathies, has gained progressive importance because of its greater diagnostic accuracy than echocardiography in detecting morphological volumetric and functional abnormalities, especially of the RV. However, the accurate assessment of morphological abnormalities of the RV using cardiac magnetic resonance imaging remains challenging, because of variability in the interpretation of individual structural anomalies. Besides, several elements come into play in the differential diagnosis of morphological anomalies of the RV, which often mislead the operator and lead to false positive results. The purpose of this review is to illustrate the use of cardiac magnetic resonance in the morphological, volumetric, and functional evaluation of the RV in this disease.