2026 SCMR Board Exam Review Course-Session 3: CMR in ischemic Heart Disease and Beyond

Video Transcription

Video Summary

This transcript is a cardiac MRI review course focused on ischemic cardiomyopathy and related diseases. Speakers covered how CMR is used in acute coronary syndromes, myocarditis, pericardial disease, systemic/inflammatory cardiac involvement, and cardiac masses.

Key points included:
- <strong>Acute MI/ACS:</strong> CMR helps determine infarct size, viability, area at risk, microvascular obstruction (MVO), intramyocardial hemorrhage, and complications such as LV thrombus. Early imaging is useful, but very early scans can overestimate infarct size due to edema; an index scan around <strong>5 ± 2 days after reperfusion</strong> was recommended.
- <strong>MINOCA:</strong> CMR is strongly recommended to identify causes of troponin elevation when coronary arteries are non-obstructive. It often distinguishes true MI from mimics like myocarditis or Takotsubo and can change management.
- <strong>Myocarditis:</strong> The lecture reviewed the <strong>Lake Louise criteria</strong>, including the original T2, early gadolinium, and LGE targets, and the updated approach using <strong>T1/T2 mapping and ECV</strong>. CMR is now a first-line test in suspected myocarditis.
- <strong>Pericardial disease:</strong> CMR characterizes effusions, acute pericarditis, constrictive pericarditis, and pericardial masses. LGE, T2 edema, and cine respiratory imaging help determine whether inflammation is active and potentially reversible.
- <strong>Systemic diseases and infections:</strong> CMR patterns help diagnose amyloidosis, Fabry disease, sarcoidosis, iron overload, eosinophilic disease, and myocarditis/pericarditis overlap.
- <strong>Cardiac masses:</strong> CMR differentiates thrombus, pseudotumors, benign tumors, metastases, and malignant primary tumors using location, mobility, tissue signal, contrast uptake, and perfusion.

The Q&A emphasized practical interpretation pitfalls, especially around mapping values, MVO vs thrombus, amyloid thresholds, sarcoid mimics, and when imaging findings should be integrated with clinical context rather than read in isolation.

Asset Caption

Purvi Parwani: CMR for Assessing Acute Coronary Syndrome 32 mins
Vanessa Ferraira: Acute Myocarditis and the Lake Louise Criteria 19 mins
Faisal Nabi: Pericardial Disease 14 mins
Jeremy Collins: CMR for Cardiac Involvement in Systemic Diseases and Infections - 32 mins
Manish Motwani: CMR for Assessing Cardiac Masses and Tumors - 21 mins
Anthon Fuisz and Elsie Nguyen: Moderated Q&A with Speakers - 45 mins

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Keywords

cardiac MRI

ischemic cardiomyopathy

acute myocardial infarction

acute coronary syndrome

MINOCA

myocarditis

Lake Louise criteria

T1 mapping

T2 mapping

extracellular volume

pericardial disease

constrictive pericarditis

amyloidosis

sarcoidosis

cardiac masses