Cardiac Magnetic Resonance in Athletes: Advanced Techniques in Sports Cardiology

The growing participation in competitive and recreational sports has increased the clinical relevance of Sports Cardiology, particularly for athletes with borderline or ambiguous findings during cardiovascular screening. Advanced imaging is essential to differentiate physiological cardiac remodeling from early or subclinical cardiomyopathy. Cardiovascular magnetic resonance (CMR) has emerged as the reference standard for comprehensive assessment of cardiac morphology, function, and myocardial tissue characterization. Beyond conventional cine imaging and late gadolinium enhancement (LGE), parametric mapping techniques (including native T1, T2, and extracellular volume (ECV) quantification) enable quantitative and reproducible evaluation of diffuse fibrosis, edema, and low-grade inflammation that may precede overt structural disease. In athletes, physiological remodeling may overlap with pathologic phenotypes, posing diagnostic and prognostic challenges. Accurate interpretation requires integration of volumetric and functional measurements with the athlete’s training profile and electrocardiographic features, using population-specific reference values to avoid misclassification of adaptive changes as pathological. This narrative review provides a clinically oriented overview of CMR in athletes, focusing on typical findings, advanced tissue characterization, and emerging techniques such as myocardial strain analysis, right ventricular-focused imaging, and 4D flow. Technical challenges, standardization issues, and future directions are discussed. Multiparametric CMR is increasingly recognized as a key tool for improving diagnostic accuracy, refining risk stratification, and supporting clinical decision-making in athletes with suspected cardiomyopathy or ventricular arrhythmias.