Interpretation of Cardiac Magnetic Resonance Post-Contrast Sequences and Late Gadolinium Enhancement in Takotsubo Syndrome

Abstract Purpose of Review To analyze the diagnostic utility of cardiac magnetic resonance (CMR) images, including post-contrast sequences and late gadolinium enhancement (LGE) findings in Takotsubo syndrome (TTS). Recent Findings TTS usually mimics acute coronary syndrome, making differential diagnosis challenging. CMR plays a key role in TTS diagnosis, particularly through T2 weighted/T2 mapping and LGE sequences. While TTS is not characterized by fibrosis replacement, LGE is detected in approximately 25% of cases, raising questions about its interpretation and prognostic relevance. Summary This perspective article aims to critically analyze the challenges in LGE interpretation, including patterns, timing, imaging protocols, and pathophysiological mechanisms in TTS. Standardization of CMR protocols and artificial intelligence-based techniques may improve accuracy. Further research is needed to explore the LGE’s impact on TTS prognosis and clinical management.