What it is (overview)

An MRI Heart with and without IV Contrast (also called a cardiac MRI) is a non-invasive diagnostic test that uses a powerful magnetic field and radio waves to create highly detailed images of your heart, heart muscle, heart valves, major blood vessels, and surrounding structures. Unlike X-rays or CT scans, MRI does not use ionizing radiation.

The test is performed in two parts:

• Without contrast: Provides detailed pictures of heart anatomy and motion—how well the heart chambers pump, how valves move, and whether the heart muscle looks thickened or enlarged.

• With IV contrast: A contrast agent (most commonly gadolinium-based) is injected into a vein to improve visibility of blood vessels and heart tissue. Contrast helps highlight blood flow and can show areas of inflammation, scar tissue, or reduced blood supply. This is especially helpful for evaluating heart disease, possible tumors, and certain structural abnormalities.

Results typically describe your heart’s size and pumping function (ejection fraction), whether the heart muscle is healthy, and whether there are signs of swelling, scar, poor blood flow, abnormal masses, or problems in the large vessels. In plain language, the results can help your clinician determine whether symptoms are coming from a heart muscle problem, a circulation issue, a valve problem, or another structural cause—and guide treatment planning (medications, procedures, or follow-up imaging).

When & why it's usually done

Your clinician may order an MRI of the heart with and without IV contrast when they need a detailed view of the heart that other tests (such as an echocardiogram, stress test, or CT) cannot fully provide. It is commonly used to evaluate both the structure of the heart and how well it functions, including blood flow patterns.

This test may be recommended if you have symptoms such as:

• Chest pain (especially when the cause is unclear after initial testing)

• Shortness of breath, reduced exercise tolerance, or unexplained fatigue

• Palpitations, fainting, or suspected rhythm-related heart problems when a structural cause is possible

• Swelling in the legs or signs of heart failure

It is also often ordered to evaluate or monitor known or suspected conditions, including:

• Cardiomyopathy (enlarged, thickened, or weakened heart muscle)

• Prior or possible heart attack and the amount of heart muscle damage (scar)

• Myocarditis (inflammation of the heart muscle) or other inflammatory conditions

• Congenital heart disease (heart conditions present from birth), including complex structural abnormalities

• Heart valve disease when precise measurement of blood flow and chamber size is needed

• Masses or suspected tumors in or around the heart to help differentiate a tumor from a blood clot or other tissue

• Diseases of the aorta and major vessels near the heart

IV contrast is specifically useful when the care team needs to assess tissue characteristics (for example, inflammation or scarring), evaluate blood supply, or better define a suspected abnormality. Your care team will consider kidney function, pregnancy status, and any implanted devices when deciding whether MRI with contrast is appropriate.

Common diseases related to it

• Coronary artery disease and complications of prior heart attack (myocardial infarction scar)
• Heart failure (reduced or preserved ejection fraction) and ventricular dysfunction
• Cardiomyopathies (dilated, hypertrophic, restrictive, arrhythmogenic right ventricular cardiomyopathy)
• Myocarditis (including viral or immune-related inflammation)
• Pericarditis and pericardial effusion; constrictive pericarditis
• Congenital heart disease (e.g., septal defects, abnormal connections, complex congenital repairs)
• Valvular heart disease (e.g., aortic stenosis/regurgitation, mitral regurgitation)
• Cardiac tumors or masses (benign or malignant) and intracardiac thrombus (blood clot)
• Aortic aneurysm, aortic dissection, or other thoracic aorta abnormalities
• Cardiac sarcoidosis, amyloidosis, or iron overload (hemochromatosis) affecting the heart

Health goals where it may help

• Clarifying the cause of chest pain, shortness of breath, or unexplained exercise intolerance
• Assessing overall cardiovascular health with high-detail cardiac imaging when other tests are inconclusive
• Measuring heart pumping function (ejection fraction) to guide medication and treatment decisions
• Detecting heart muscle inflammation or scarring to support diagnosis and recovery planning
• Monitoring known heart disease over time, including response to therapy
• Evaluating suspected structural abnormalities (chamber size, wall thickness, valve-related effects)
• Characterizing a suspected cardiac mass (tumor vs. clot) to help plan next steps
• Pre-procedure or pre-surgical planning for congenital heart disease or complex cardiovascular conditions