Inside the myocardial wall: do we have enough imaging power to assess the transumural distribution of ischemia and scar?

In patients with myocardial infarction, contrast MRI has an emerging role as gold standard for the transmural characterization of viable myocardium that has not yet entered clinical cardiology for several reasons, such as cost and availability. As a consequence the transmural extent of scar is not yet a clinical question that allows the use of cMRI as a first line diagnostic tool. In the meantime, preliminary data suggest that beyond ischemia Myocardial Perfusion Scintigraphy (MPI) reflects enough "transmurality" in the assessment of viability.