Foundations of CMR: Level 1 Virtual Course-SESSION 5: INFECTIONS/INFLAMMATIONS & BEYOND

Video Transcription

Video Summary

The session focused on imaging of inflammatory, infective, and genetic cardiomyopathies, using multiple cases and expert discussion.<br /><br />Dr. Chetan Shenoy opened with cardiac sarcoidosis, emphasizing that it is frequently missed clinically but can also be overcalled on imaging. He reviewed pathology-proven cases and argued that the most diagnostic CMR pattern is a combination of subepicardial/RV-side septal involvement, multifocal lesions, septal predilection, and RV free-wall involvement. He stressed that absence of LGE makes cardiac sarcoidosis very unlikely, while the typical LGE pattern strongly predicts ventricular arrhythmias and sudden death, supporting ICD consideration. He also advised that imaging alone should not establish the diagnosis; tissue confirmation is preferred. He highlighted cardiac TB as an important mimic, especially in India.<br /><br />Dr. Priya expanded on cardiac tuberculosis, covering its epidemiology, modes of spread, and broad manifestations including pericarditis, constrictive physiology, myocardial infiltration, valvular disease, and rare intracardiac masses. She showed that CT, echo, PET, and CMR can suggest TB, but biopsy or microbiologic confirmation is often needed. She presented cases demonstrating pericardial TB, myocardial TB, and overlap with sarcoidosis.<br /><br />Dr. Vanessa Ferreira reviewed CMR in myocarditis, summarizing the Lake Louise criteria and illustrating how T2-based and T1-based abnormalities, plus LGE, support diagnosis. Her cases showed acute and chronic/severe myocarditis, and she noted that CMR cannot reliably identify the exact viral cause.<br /><br />Dr. Nitin Borkule discussed genetic cardiomyopathies, showing how ring-like LGE, disproportionate fibrosis, and characteristic patterns can suggest desmosomal disease or iron overload. He highlighted the role of genetic testing and integrated phenotype-genotype diagnosis.<br /><br />A final discussion stressed practical reporting, the need for tissue diagnosis where possible, and the value of whole-body PET and multidisciplinary interpretation.

Keywords

cardiac sarcoidosis

cardiac tuberculosis

myocarditis

cardiomyopathy

cardiac MRI

CMR

late gadolinium enhancement

Lake Louise criteria

ventricular arrhythmias

sudden cardiac death

PET imaging

tissue diagnosis

genetic cardiomyopathies

desmosomal disease

whole-body PET