Cardiac MRI in autoimmune diseases: where are we now?

Cardiovascular magnetic resonance imaging (CMR) allows the early diagnosis of various cardiovascular pathophysiologic phenomena in autoimmune diseases. Preliminary studies suggest that CMR holds a promising role in initiating the necessary changes in anti-rheumatic and cardiac treatment among patients with autoimmune diseases and cardiovascular diseases (CVD). It is widely known that the presence of late gadolinium enhancement (LGE) has been related to worse cardiovascular prognosis. CMR has been documented to be the most valuable tool for diagnosis and risk prediction of cardiac involvement in a sarcoidosis population, while in SLE, the gap between clinical and autopsy diagnosis of myocardial disease could be narrowed with the implementation of CMR. In different connective tissue diseases, including SLE, LGE has been demonstrated to be present, early after the initial diagnosis of SLE. Considering that CMR including LGE identifies more patients with silent myocardial disease in SLE and other connective tissue diseases than echocardiography, CMR should be the preferred imaging modality, especially in the era of modern techniques with a broader availability and expertise. In this review, we summarize the major indications, advantages and limitations of the use of CMR among patients with autoimmune disorders.