Table 2.

Differential diagnosis table for delayed myocardial enhancement in cardiac MRI.

Diagnosis	Clinical manifestation	Pattern of enhancement
Ischemic cardiomyopathy	Fatigue, shortness of breath, chest pain, palpitations, pulmonary edema, and leg swelling	Subendocardial and/or transmural
Hypereosinophilic syndrome	Symptoms of heart failure, intracardiac thrombus, myocardial ischemia, arrhythmias, and rarely pericarditis	Subendocardial and/or global endocardial
Amyloidosis	Symptoms indicative of restrictive cardiomyopathy (cardiac amyloidosis is the most common cause of restrictive cardiomyopathy)	Global endocardial
Systemic sclerosis	Cardiac manifestations can affect all structures of the heart, and may result in pericardial effusion, arrhythmias, conduction system defects, valvular impairment, myocardial ischemia, myocardial hypertrophy and heart failure	Global endocardial
Churg-Strauss Syndrome	Symptoms consistent with cardiomyopathy as a consequence of vasculitis- related ischemia affecting small myocardial vessels and coronary arteries, or from eosinophilic or granulomatous myocardial infiltration	Global endocardial
Dilated Cardiomyopathy	Ventricular enlargement and systolic dysfunction. Disease progression may lead to mitral and tricuspid valve regurgitation and eventually heart failure	Mid wall
Hypertrophic Cardiomyopathy	Thickening of the myocardium, most commonly affecting the septum. This may lead to left ventricular outflow obstruction and eventually heart failure	Mid wall
Duchenne’s Muscular Dystrophy	Myocardial damage likely related to mechanical stress imposed on a metabolically and structurally abnormal myocardium. Fibrosis commonly occurs in the inferolateral wall	Mid wall and/or subepicardial, typically inferolateral wall
Becker’s Muscular Dystrophy	Myocardial damage has been postulated to result from mechanical stress imposed on a metabolically and structurally abnormal myocardium. Fibrosis commonly occurs in the inferolateral wall.	Mid wall, typically inferolateral wall
Myocarditis	Cardiac manifestation may result in chest pain, fever, sweats, chills, dyspnea, palpitations, syncope, heart failure, and sudden death	Mid wall and/or subepicardial
Anderson-Fabry Disease	Clinical disease manifestations include left-ventricular myocardial hypertrophy, valvular thickening, and ectasia of the ascending aorta and conduction abnormalities. Myocardial fibrosis is typically an end-stage manifestation.	Mid wall
Sarcoidosis	Symptoms of cardiac sarcoidosis may include congestive heart failure, conduction abnormalities, atrial and ventricular arrhythmias, and sudden death. In its early stages, sarcoid is an active inflammatory disorder that may cause myocardial edema, which may progress to fibrosis	Mid wall and/or subepicardial