Clinical Applications of Cardiac Diffusion MRI: A Scoping Review.

Purpose To characterize the extent, clinical applications, and emerging trends of diffusion-weighted imaging (DWI) techniques in cardiac MRI using a scoping review of in vivo human studies. Materials and Methods A scoping review was performed using systematic search methods. Ovid MEDLINE All, Ovid Embase, and Cochrane Library databases were searched from inception through March 2025. Two reviewers independently screened studies and extracted data on study characteristics, imaging techniques (DWI, cardiac diffusion tensor imaging, intravoxel incoherent motion), and clinical applications. Study quality was assessed using the Newcastle-Ottawa scale, and findings were synthesized descriptively without pooled analysis due to heterogeneity. Results Of 9721 identified records, 55 studies met the inclusion criteria. Most studies evaluated hypertrophic cardiomyopathy (n = 20) and ischemic heart disease (n = 17), with fewer studies in athletes and exercise (n = 5) and other cardiac conditions. The median sample size was 40 (IQR, 23-60). DWI demonstrated high sensitivity (83.1%-97%) and specificity (90%-100%) for detecting acute myocardial infarction in selected studies, while cardiac diffusion tensor imaging metrics, including mean diffusivity and fractional anisotropy, identified microstructural abnormalities in hypertrophic cardiomyopathy and ischemic heart disease. Intravoxel incoherent motion was less frequently studied but showed potential for assessing microvascular dysfunction. Evidence in athletes, exercise, and other cardiac pathologies was limited. Despite promising findings, heterogeneity in acquisition protocols, small sample sizes, and lack of longitudinal data limited clinical translation. Conclusion Diffusion imaging techniques show potential for characterizing myocardial microstructure and pathology, but variability in methodology and limited clinical validation currently constrain broader clinical adoption. Keywords: Cardiac, MRI, DWI, Diffusion-weighted Imaging, Diffusion Tensor Imaging, Intravoxel Incoherent Motion Supplemental material is available for this article. © RSNA, 2026.