Late gadolinium enhancement in patients with and without autoimmune rheumatic diseases: "walking, we create the way"

George Markousis-Mavrogenis; Alessia Pepe; Brittany N Weber; Anne Hui Sze Kwong; Vassiliki Vartela; Monica Mukherjee; Juerg Schwitter; Sophie I Mavrogeni

doi:10.1016/j.ejrad.2025.112542

Late gadolinium enhancement in patients with and without autoimmune rheumatic diseases: "walking, we create the way"

Eur J Radiol. 2026 Feb:195:112542. doi: 10.1016/j.ejrad.2025.112542. Epub 2025 Nov 19.

Authors

George Markousis-Mavrogenis¹, Alessia Pepe², Brittany N Weber³, Anne Hui Sze Kwong⁴, Vassiliki Vartela⁵, Monica Mukherjee⁶, Juerg Schwitter⁷, Sophie I Mavrogeni⁸

Affiliations

¹ University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.
² Department of Medicine DIMED, University of Padova, 35128 Padua, Italy; Institute of Radiology, University-Hospital of Padova, 35128 Padua, Italy.
³ Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
⁴ Circle Cardiovascular Imaging, Paris, France.
⁵ Onassis Cardiac Surgery Center, Athens, Greece.
⁶ Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA.
⁷ Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Cardiac MR Center of the University Hospital Lausanne and CMR Corelab (swissCVIcorelab, CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine, Lausanne University (UniL), Lausanne, Switzerland.
⁸ University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece; Onassis Cardiac Surgery Center, Athens, Greece. Electronic address: sophie.mavrogeni@gmail.com.

PMID: 41289723
DOI: 10.1016/j.ejrad.2025.112542

Abstract

Myocardial fibrosis constitutes an important pathophysiologic and maladaptive process in the vast majority of cardiac diseases. Contemporary cardiologists are permitted a very nuanced glimpse of myocardial fibrosis by means of cardiovascular magnetic resonance imaging (CMR), and specifically late gadolinium enhancement (LGE) methods. These allow the evaluation of the presence, extent, and distribution of myocardial replacement fibrosis. An increasing amount of scientific evidence has demonstrated a significant role for LGE in the elucidation of cardiac pathophysiologic substrates in patients with autoimmune rheumatic diseases (ARDs) and cardiac involvement. However, whether existing methods for the evaluation of myocardial fibrosis can uniformly be extrapolated for use in patients with ARDs in their present form remains an important question. In this opinion paper, we provide a brief overview of the basic principles underlying LGE imaging, as well as the current status and challenges regarding its use in patients with and without ARDs.

Keywords: Autoimmunity; Cardiac involvement; Cardiovascular disease; Cardiovascular magnetic resonance; Connective tissue disease; Risk stratification.

Publication types

Review

MeSH terms

Autoimmune Diseases* / complications
Autoimmune Diseases* / pathology
Contrast Media* / administration & dosage
Gadolinium* / administration & dosage
Humans
Image Enhancement* / methods
Magnetic Resonance Imaging* / methods
Rheumatic Diseases* / complications
Rheumatic Diseases* / pathology

Substances

Contrast Media
Gadolinium