skip to main content

LGE Patterns - Sarcoidosis vs MI — EECC MCQ

Instant feedback + full explanation. One question, done properly.

EasyCardiac ImagingLGE Patterns - Sarcoidosis vs MIEECC

A 52-year-old woman with suspected cardiac sarcoidosis undergoes CMR. The radiologist reports LGE in the basal septum, extending towards the epicardium, with corresponding oedema. How does the LGE pattern in cardiac sarcoidosis differ from that of a myocardial infarction?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Sarcoidosis causes patchy, mid-wall, or epicardial LGE often in a non-coronary distribution, whereas MI causes subendocardial-to-transmural LGE following a coronary territory

LGE patterns on CMR are crucial for aetiological diagnosis. Myocardial infarction produces subendocardial or transmural LGE that follows a coronary artery territory distribution, progressing from the subendocardium outward (reflecting the 'wavefront' of ischaemic necrosis). Cardiac sarcoidosis produces patchy, mid-wall, or epicardial LGE that does not follow coronary territories, often affecting the basal septum and lateral wall. Sarcoidosis LGE can mimic other non-ischaemic patterns but the combination of patchy distribution, septal involvement, and active inflammation on FDG-PET is characteristic. The 2023 ESC Cardiomyopathy Guidelines use CMR LGE patterns as a key diagnostic feature.

Reference: ESC (2023): Guidelines on Cardiomyopathies