CMR — Cardiac MRI
MRINICE NG2082021ESC Cardiomyopathy 2023ESC Myocarditis 2025NICE CG952010, updated November 2016v2.0 · March 2026
Varies
InpatientOutpatient
All imaging requests must be justified by an IR(ME)R practitioner (radiologist or radiographer)Cardiomyopathy (ESC 2023 Class I)
— ANY of the following
- HCM, DCM, ARVC, cardiac amyloidosis, Fabry diseaseESC Cardiomyopathy 2023
- LGE identifies characteristic scar patterns
- T2* mapping for cardiac iron overload
Myocarditis (Modified Lake Louise Criteria)
≥1 T2-based criterion (oedema) AND ≥1 T1-based criterion (injury/fibrosis)
- ≥1 T2-based criterion (oedema) AND ≥1 T1-based criterion (injury/fibrosis)ESC Myocarditis 2025
- Troponin rise with unobstructed coronaries
- New-onset heart failure of unknown cause
- New ventricular arrhythmias
Valvular disease (NG208)
— ANY of the following
- Echo quality suboptimalNICE NG208
- Regurgitant lesion quantification discordant
- RV assessment (first-line for pulmonary valve)
- Mid-wall fibrosis detection in severe aortic stenosis
Congenital heart disease (ESC 2020)
— ANY of the following
- Gold standard for RV quantification post-Tetralogy of FallotESC 2020
- Qp:Qs shunt quantification
- Coarctation assessment
- Preferred over CT for serial imaging in young patients (no radiation)
Stress perfusion CMR (CG95)
— ANY of the following
- Second-line for known CAD with new symptoms or inconclusive CTCANICE CG95
- Equivalent evidence to stress echo and MPS-SPECT
Notes
Information
CMR is gold standard for non-invasive myocarditis diagnosis
Information
Echo remains first-line for valvular disease
NICE NG208Local preference
CMR preferred over CT for serial cardiac imaging in young patients
Pregnancy
CMR can be performed in pregnancy if clinically indicated. Gadolinium contraindicated except when essential.
Change Log
v2.02026-03-08New protocol — cardiac MRI indications consolidated