Stress cardiac MRI allows morphologic and functional evaluation, ischemia detection and viability determination with excellent accuracy in only one examination. When compared to other concurrent test such SPECT or stress echo, the capability to diagnose beyond ischemia is not taken in account. We think that this is an important add value often forgotten, that benefits the MR examination. Our purpose is to identify the proportion of non ischemic previously unsuspected diagnoses with clinical implications in our adenosine-stress cardiac MR patients.

From a series of consecutive patients submitted to stress cardiac MRI with adenosine, we have selected those in which a previously unknown diagnosis with clinic and therapeutic implications was found. All patients had a previous (less than 3 months) echocardiography. The way we perform the MR examination is the following: - A morphological and anatomic analysis is currently carried out with initial determination of the cardiac planes. - Then, a myocardial perfusion evaluation (after endovenous gadolinium bolus at 0,1mmol/Kg, 4ml/sec.) with adenosine (administratedat a dosis...

Of the 178 stress cardiac MRI examinations performed at our institution between January 2011 and December 2012, 22 new non-ischemic significant diagnoses, previously unknown,were found: - 7 hypertrophic cardiomyopathies; - 1dilated cardiomyopathy; - 1 apical thrombus; - 4 lung nodules; - 1 ascending aorta dilatation; - 1 chronic pulmonary thromboembolism; - 7 delayed enhancement patterns of non-ischemic etiology (5 of those typical of myocarditis). 
 Also detected were8 unknown oldinfarcts. All the examinations were diagnostic and concluded without major complications. We now illustrate the mentioned findings:...

Stress cardiac MRI with adenosine is a safe method to diagnose, locate and determine the extension of myocardial ischemia. Moreover, it allows evaluation beyond ischemia and viability. In our series, 12.4% of patients had benefit from the global cardiac evaluation capability of MRI, with relevant non-ischemic diagnostic findings, previously unknown, that changed their management.

- Bruder et al. European cardiovascular magnetic resonance (EuroCMR) registry – multi national results from 57 centers in 15 countries. Journal of Cardiovascular Magnetic Resonance 2013, 15:9. - Jens Vogel-Claussen et al. Delayed Enhancement MR Imaging: Utility in Myocardial Assessment. RadioGraphics 2006; 26:795–810. - Orla Buckley, Marcelo Di Carli. Predicting Benefit From Revascularization in Patients With Ischemic Heart Failure: Imaging of Myocardial Ischemia and Viability. Circulation 2011; 123:444-450. - Christopher M. Walker, Jonathan H. Chung, and Gautham P. Reddy. Non-ischemic Delayed Enhancement. J Thorac Imaging,...

- C.Leal is a Radiology Consultant at "Hospital de Santa Marta - CHLC". - H. M. R. Marques, R.Santos, N. Costa are Radiology Consultants at "Hospital de Santa Marta - CHLC" and at "Hospital da Luz". - M. S.C.Sousa is a Resident of Radiology at "Hospital do Espírito Santo, Évora". - N. Cardim is a Cardiologist Senior Consultant and P.Gonçalves andA. Ferreira are Cardiologist Consultants at "Hospital da Luz". - V.Mascarenhas andA.Guerra are Radiology Consultants at "Hospital da Luz".