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This review highlights the diagnostic and prognostic value of cardiac magnetic resonance and computed tomography in the assessment of cardiomyopathies. While echocardiography remains the first\u2010line imaging modality, cardiac magnetic resonance (CMR) and cardiac computerized tomography (CCT) offer superior tissue characterization, morphological assessment, and functional evaluation, crucial for phenotyping cardiomyopathies into hypertrophic, dilated, restrictive, arrhythmogenic, and non\u2010dilated left ventricular subtypes. For hypertrophic cardiomyopathy, CMR enables precise identification of fibrosis, hypertrophy distribution, and risk stratification for sudden cardiac death. CMR is pivotal in identifying phenocopies, like cardiac amyloidosis and Anderson\u2013Fabry disease, and differentiating between pathological and physiological remodeling in athlete's heart. For dilated cardiomyopathy, late gadolinium enhancement, T1 mapping, and extracellular volume measurements aid in distinguishing etiologies and predicting adverse outcomes. In arrhythmogenic right ventricular cardiomyopathy, CMR demonstrates superior sensitivity for detecting structural abnormalities in the right ventricle, and the presence of fibrosis which is associated with arrhythmic risk. CCT main roles are excluding coronary artery disease and complementing CMR. This review proposes a diagnostic pathway integrating multimodality imaging for clinical management in cardiomyopathies.<\/jats:p>","DOI":"10.1111\/echo.70104","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T07:10:36Z","timestamp":1739862636000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["CT and MR Imaging of Cardiomyopathies in Clinical Practice\u2013An Approach After an Abnormal Echocardiogram or Electrocardiogram"],"prefix":"10.1111","volume":"42","author":[{"given":"Pedro","family":"Monteiro","sequence":"first","affiliation":[{"name":"Department of Cardiology Unidade Local de Sa\u00fade de Santo Ant\u00f3nio  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago","family":"Peixoto","sequence":"additional","affiliation":[{"name":"Department of Cardiology Unidade Local de Sa\u00fade de Santo Ant\u00f3nio  Porto 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