The role of noninvasive imaging to help guide transcatheter aortic valvular interventions is well established and has grown with the advances in the procedure. With the rapid development of new transcatheter mitral valve interventions there is both an opportunity and a challenge for noninvasive imaging to grow understanding of mitral valve anatomy and disease, help with patient selection, and improve downstream clinical outcomes. This review will discuss the role of both echocardiography and multidetector CT in the diagnosis of mitral regurgitation, as well as grading of its severity and defining its etiology. Additionally, new concepts including measurements pertaining to mitral annular sizing, segmentation of mitral annular calcium, prediction of neo-left ventricular out flow tract obstruction, hybrid or fusion multidetector CT/echocardiographic imaging, and CT-based fluoroscopic guidance will be discussed.