Diagnostic work-up of arrhythmogenic right ventricular cardiomyopathy by cardiovascular magnetic resonance

Cardiovascular magnetic resonance (CMR) has become a widespread diagnostic tool. Since its introduction, CMR has been used to image patients with a known or suspected arrhythmogenic right ventricular cardiomyopathy (ARVC). Several abnormalities have been found and described by CMR and at present this diagnostic tool is considered very important for the diagnosis. However, the diagnosis of ARVC relies upon the fulfillment of both clinical and functional criteria and CMR can provide several but not all the information useful for the diagnosis. Furthermore, some findings such as evidence of right ventricular epicardial fat, once considered a peculiar marker of ARVC, have been shown to possess a low specificity. This document was prepared by representatives of the three Italian official Organizations involved in CMR. Its main scope is to highlight the problems encountered when studying patients with suspected ARVC at CMR, to indicate the basic technical equipment needed, to recommend a proper imaging protocol and to offer a consensus on the main features relevant for the diagnosis.