Tissue composition changes such as fibrosis, edema, or infiltration are frequent features in myocardial diseases Cardiac imaging modalities offer the ability to characterize myocardial tissue to varying extent Cardiovascular magnetic resonance offers comprehensive myocardial tissue characterization providing various diagnostic and prognostic imaging biomarkers Advanced cardiac imaging is expected to become an integral part in risk-stratification and personalized medicine ABSTRACT Myocardial fibrosis, either focal or diffuse, is a common feature of many cardiac diseases and is associated with a poor prognosis for major adverse cardiovascular events. While histological analysis remains the gold standard for confirming the presence of myocardial fibrosis, endomyocardial biopsy is invasive, suffers from sampling errors, and is not practical in the routine clinical setting. Cardiac imaging modalities offer non-invasive surrogate biomarkers not only for fibrosis but also for myocardial edema and infiltration to varying degrees, and have important roles in the diagnosis and management of cardiac diseases. This review summarizes important pathophysiologic features in the development of commonly-encountered cardiac diseases, and the principles, advantages and disadvantages of various cardiac imaging modalities (echocardiography, single photon emission computer tomography, positron emission tomography, multi-detector computer tomography, and cardiovascular magnetic resonance imaging) for myocardial tissue characterization, with an emphasis on imaging focal and diffuse myocardial fibrosis.