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Cardiac involvement in various systemic conditions, such as inflammatory diseases (sarcoidosis and transplant rejection), storage diseases (amyloidosis, Fabry disease, and haemochromatosis), or cancer chemotherapy, is increasingly recognized as a key factor limiting patient survival.1 To guide preventive measures and therapy, early and accurate diagnosis of cardiac involvement is desired. This, however, often remains a challenge:Endomyocardial biopsy is specific, but limited by its invasive nature which precludes its use as an early screening tool,2 and by sampling errors which may cause false-negative results in the case of biopsies from unaffected regions. Non-invasive functional imaging such as echocardiography, radionuclide ventriculography, or cine magnetic resonance imaging can be used to identify cardiomyopathy, but the detection of left ventricular dysfunction may be non-specific with regard to the underlying cause.3 Accordingly, there is a trend towards more specific techniques for non-invasive myocardial tissue characterization:4 advanced magnetic resonance techniques such as delayed gadolinium enhancement, fibrosis, or oedema imaging may be used to identify patterns of tissue alteration that are more specific to the underlying origin of cardiomyopathy.5 Also, radiotracer …

The non-invasive biopsy: molecular imaging for the detection of cardiac involvement in systemic disease