CMR provides superior spatial resolution and tissue characterization. The hallmark of CS on CMR is the presence of Late Gadolinium Enhancement (LGE), which highlights areas of focal fibrosis, scarring, and myocardial necrosis. LGE typically presents in a patchy, mid-myocardial or sub-epicardial pattern that does not conform to a specific epicardial coronary artery territory, differentiating it from ischemic cardiomyopathy. Beyond initial diagnosis, the presence of LGE is a powerful independent predictor of major adverse cardiac events (MACE), including ventricular tachycardia and sudden death, and helps guide decisions about prophylactic ICD implantation in conditions such as cardiac sarcoidosis and other non-ischemic cardiomyopathies where LGE burden correlates with arrhythmic risk.
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