PURPOSE OF REVIEW: Myocardial fibrosis is a common feature of many 
cardiomyopathies, including hypertrophic cardiomyopathy. Myocardial fibrosis has 
been shown to be reversible and treatable with timely intervention. Although 
early detection and assessment of fibrosis is crucial, adequate diagnostics are 
still in development. Recent studies have shown progress on noninvasive imaging 
methods of fibrosis using cardiovascular magnetic resonance (CMR) and nuclear 
imaging modalities.
RECENT FINDINGS: T1 mapping and extracellular volume mapping (ECV) combined with 
CMR imaging are cutting edge methods that have the potential to assess 
interstitial myocardial fibrosis. Recent findings show that ECV measurement can 
be correlated to the extent of diffuse fibrosis. Comparatively, molecular 
imaging targets specific biomarkers in the fibrosis formation pathway and 
provides enhanced sensitivity for imaging early disease. Biomarkers include 
molecules involved in angiogenesis, ventricular remodeling, and fibrotic tissue 
formation, whereas collagen targeted agents can directly identify fibrotic 
tissue in the heart.
SUMMARY: This review introduces novel methods of fibrosis imaging that utilize 
properties of extracellular matrix and its biomarkers. Changes in 
characteristics and cellular biomarkers of the extracellular space can provide 
significant information regarding fibrosis formation and its role in 
cardiomyopathy. Ultimately, these findings may improve detection and monitoring 
of disease and improve efficiency and effectiveness of the treatment.