Table 4.

Arguments against and in favor of preparticipation screening MRI.

Objections to MRI screening [18]	Support for MRI screening [3], [12]
1.Only “treatable” causes should be screened.	1.There is no way to screen only for so-called treatable causes; we need to do accurate systematic screening and then individual evaluation of potential hr-CVCs.
2.The real incidence of SCD is unknown, but it is “extremely low.”	2.The real incidence of SCD can only be described by accurate methods used in all candidates (the denominator of carriers at risk is essential). In general, all mortality (in athletes especially) should be eliminated if possible.
3.The mechanisms of SCD are unknown.	3.The risks and mechanisms of SCD can be better studied in vivo, in individual cases identified by s-MRI screening, than by autoptic study.
4.Screened adolescents will feel anxious and condemned or disabled by knowing the diagnosis; psychological impact follows.	4.Preparticipation-screened adolescents cannot feel anxious or condemned because of the risk, more than because of the clear explanation of an eventual issue (if any) and its treatment (frequently efficacious and available).
5.Mortality risk from hr-CVCs is low; finding an hr-CVC does not equate to finding mortality risk.	5.We need to describe the precise risk by accurately quantifying the severity of hr-CVCs and strict follow-up for mortality; s-MRI enables this job accurately, by primary-level protocol.
6.Mass screening of adolescents affects persons who will not be athletes.	6.We propose that only elite athletes be MRI-screened (high school, college, and professional athletes). We are interested in hr-CVCs, not all possible anatomical anomalies.
7.The role of exercise is unclear.	7.Most high-quality reports have found that 90% of SCD in athletes occurs during exertion: we could validate this by using a fixed-exercise program in military recruits (2 months long, advanced level).
8.Athletic screening is like “opening the Pandora’s box” while introducing or inventing previously unknown troubles.	8.Pandora was a curious girl, and she got in trouble, but athletes are serious and motivated, while looking for clarity and peace of mind (“How much can I push?”): they expect scientific evidence.
9.AED on the field with resuscitation is the primary and optimal policy for preventing death.	9.AED is welcome, but it may not be enough: Large surveys on mortality and irreversible brain damage rates after AED and out-of-hospital resuscitation quote 50–90% negative endpoints.

AED, automated external defibrillation; hr-CVC, high-risk cardiovascular condition; MRI, magnetic resonance imaging; SCD, sudden cardiac death. See text.