The Importance of Recognizing and Remedying Artefacts in CMR: Tumour Mimics

Description of Clinical Presentation: A middle-aged man with a family history of hypertrophic cardiomyopathy and a diagnosis of hypertension was recalled for a second scan after a potential mass was noted in the right ventricle (RV) on his initial scan, only late after the injection of gadolinium contrast.

Diagnostic Techniques and Their Most Important Findings: The initial CMR scan was performed on a 3T platform. Four-chamber balanced steady-state free precession (b-SSFP) sequences cine view revealed a possible mass within the RV, which was also present on the early and late gadolinium enhancement (LGE) sequences (FIG 1). The short-axis cine images demonstrated the suspected mass with less clarity, whereas it appeared more conspicuous on the LGE sequences. No further RV images were taken. As the possible mass was not identified prior to contrast injection, the interpreting consultant requested a repeat CMR study to characterise the lesion. The second scan was conducted on a 1.5T scanner. Prior to image acquisition, the previous images were carefully reviewed, and on closer assessment, the suspected mass was more consistent with an off-resonance artefact—likely due to suboptimal shimming at 3T combined with gastric air, as the mass was not consistent in all planes (FIG 2). Repeat b-SSFP sequences in long- and short-axis views, shimmed properly, revealed no RV mass, a finding confirmed on post-contrast imaging (FIG 3). No further characterisation was required.

Learning Points from this Case: This case highlights the essential role of the radiographer in the accurate acquisition, optimisation, and first interpretation of CMR. Beyond operating the scanner, radiographers must be able to recognise subtle anatomical variations, identify potential artefacts in real time, and adapt imaging protocols to ensure a prompt and correct diagnosis. In this instance, the failure to detect and address the artefact during the initial examination led to an unnecessary patient recall and additional use of resources. The second scan demonstrated the value of careful image review and the ability to apply corrective measures on the spot. These findings reinforce the necessity for robust and comprehensive training, ensuring radiographers are confident and competent in both standard and complex cases. It also illustrates the challenges of scanning at 3T and the importance of good shimming, particularly at higher field strengths. Ultimately, the proficiency of the radiographer directly impacts diagnostic accuracy, clinical decision-making, and the overall quality of CMRI services; therefore, it is vital for the radiographers to have continuous professional development through advanced education programmes, hands-on specialist courses, and active participation in national and international conferences.

FIG 1- 4 Ch cine view in b-SSFP (1)- Early gadolinium enhancement (2) and late gadolinium enhancement (3) demonstrating a potential mass in the RV
FIG 2- Localizer b-SSFP (1) and short Axis b-SSFP demonstrating the region of the artefact.
FIG 3- Follow up scan showing 4 Ch cine view in b-SSFP (1)- Early gadolinium enhancement (2) and late gadolinium enhancement (3) demonstrating no mass in the RV.