MRI Cardiac Function and Morphology — Dictation, Appropriateness, and Dose for Residents

Cardiology is on the line. 35-year-old with new-onset heart failure, troponins are equivocal, and the echo shows global hypokinesis but can’t rule out an infiltrative process. They need to know: is this myocarditis, amyloid, or something else entirely? Your attending expects a full functional analysis, tissue characterization with T1 and T2 mapping, and a definitive take on the Late Gadolinium Enhancement (LGE) pattern. Juggling the post-processing for ejection fraction while trying to recall the specific LGE patterns for sarcoid versus amyloid under pressure is the reality of a complex cardiac MRI read.

When I was a fellow, these were the cases that could make or break a rotation. The report needs to be more than just numbers; it needs to tell a clinical story that guides the next step in management. This guide is built to get you there faster, with a solid template and the key principles your attending is looking for. For more tools like this, check out the free trainee calculators and references we’ve put together.

What an MRI for Cardiac Function and Morphology Covers and What Attendings Look For

A comprehensive cardiac Magnetic Resonance Imaging (MRI) is the gold standard for assessing cardiac morphology, function, and tissue characterization, all without ionizing radiation. It’s the problem-solving tool cardiologists turn to when echocardiography is inconclusive. The study is designed to provide a complete picture of the heart’s structure, pumping ability, and the health of the myocardium itself.

Your attending will expect a systematic evaluation covering several key domains. A rock-solid report will always address:

• Ventricular Function and Volumes: Left and Right Ventricular Ejection Fractions (LVEF/RVEF), end-diastolic and end-systolic volumes, stroke volume, and cardiac output, derived from cine Steady-State Free Precession (SSFP) sequences.
• Myocardial Mass: Quantification of the left ventricular mass.
• Wall Motion: Segmental and global wall motion abnormalities, which can point toward ischemic or nonischemic etiologies.
• Tissue Characterization: This is where cardiac MRI shines. You’ll assess for edema (myocarditis, acute infarct) using T2-weighted imaging or T2 mapping, and for fibrosis or infiltration using Late Gadolinium Enhancement (LGE) and T1 mapping (which allows calculation of the Extracellular Volume fraction, or ECV).
• Pericardial Disease: Evaluation for pericardial thickening, effusion, and the specific physiologic signs of constriction like septal bounce.
• Valvular Assessment: Qualitative and sometimes quantitative assessment of valvular stenosis or regurgitation.
• Cardiac Masses: Characterization of any identified masses, differentiating thrombus from tumor.

Radiology Report Template for MRI Cardiac Function and Morphology

This template provides a reliable structure for your dictation. You can adapt it for your institution’s macros in PowerScribe or other voice recognition software. The key is to be systematic, ensuring you cover all the critical components from function to tissue characterization.

Technique

Multiplanar, multisequence MRI of the heart was performed with ECG gating and breath-holding on a [1.5T or 3.0T] scanner. The protocol included cine SSFP sequences in short-axis, 2-chamber, 3-chamber, and 4-chamber views. T1 and T2 mapping sequences were also obtained. Following the administration of [0.1 mmol/kg of macrocyclic gadolinium-based contrast agent], first-pass perfusion and delayed inversion-recovery sequences for late gadolinium enhancement were performed. Post-processing was performed on a dedicated workstation for calculation of ventricular volumes and function.

Findings

LEFT VENTRICLE:
Size: Normal / Mildly / Moderately / Severely dilated.
End-diastolic volume (EDV): [___] mL (indexed: [___] mL/m²).
End-systolic volume (ESV): [___] mL (indexed: [___] mL/m²).
Ejection fraction (LVEF): [___]%.
Myocardial mass: [___] g (indexed: [___] g/m²).
Wall thickness: Normal / Asymmetric septal hypertrophy / Concentric hypertrophy.
Wall motion: Normal / Global hypokinesis / Regional wall motion abnormalities in the [e.g., LAD, LCx, RCA] territory.

RIGHT VENTRICLE:
Size: Normal / Mildly / Moderately / Severely dilated.
End-diastolic volume (EDV): [___] mL (indexed: [___] mL/m²).
End-systolic volume (ESV): [___] mL (indexed: [___] mL/m²).
Ejection fraction (RVEF): [___]%.
Wall motion: Normal / Abnormal.

ATRIA:
Left atrium: Normal / Mildly / Moderately / Severely dilated.
Right atrium: Normal / Mildly / Moderately / Severely dilated.

MYOCARDIAL TISSUE CHARACTERIZATION:
T2/STIR/T2 Mapping: No myocardial edema. / Myocardial edema is present in the [specify segments].
Late Gadolinium Enhancement (LGE): None. / LGE is present in a [subendocardial, midwall, subepicardial, transmural] pattern involving the [specify segments].
T1 Mapping/ECV: Native T1 is [___] ms. Post-contrast T1 is [___] ms. Calculated ECV is [___]%. (Normal/Elevated).

VALVES:
Aortic/Mitral/Tricuspid/Pulmonic: Structurally normal. No significant stenosis or regurgitation. / [Describe abnormality].

PERICARDIUM:
Normal thickness, no effusion. / Pericardial thickening measuring up to [___] mm. Small/moderate/large pericardial effusion. No evidence of constrictive physiology.

GREAT VESSELS:
Aorta and pulmonary artery are normal in course and caliber.

Impression

This is your summary—the part the clinicians read first. Start with the most important finding. Use this checklist to make sure you’ve synthesized the key data points.

• Primary Finding: e.g., “Severely reduced left ventricular systolic function (LVEF [___]%) with a pattern of late gadolinium enhancement consistent with nonischemic cardiomyopathy, likely myocarditis.”
• LVEF, RVEF, and Volumes: Always state the ejection fractions clearly.
• LGE Pattern and Significance:
  • Subendocardial/Transmural: Ischemic (coronary distribution).
  • Midwall: Nonischemic (DCM, sarcoidosis, myocarditis).
  • Subepicardial: Myocarditis, sarcoidosis.
  • Diffuse: Amyloidosis (mention difficult myocardial nulling).
  • RV Insertion Points: Pulmonary hypertension, ARVC.
• Evidence of Edema (T2): Mention if present, as it indicates acute injury (myocarditis, acute infarct).
• T1/ECV Findings: Note if elevated, suggesting diffuse fibrosis or infiltration (amyloidosis).
• Key Secondary Findings: Pericardial disease, significant valvulopathy, cardiac mass.

Free Radiology Template Sources

Building your own macro library is a rite of passage, but you don’t have to start from scratch. For residents and fellows looking to browse a wide range of templates beyond what’s in this guide, two great free repositories exist. These are excellent, non-commercial resources maintained by and for radiologists.

• RadReport.org: Curated by the RSNA, this is a comprehensive library of peer-reviewed templates covering nearly every modality and subspecialty.
• Radiology Templates (AU): An Australian-maintained library with a clean interface and practical, clinically-focused templates.

The Next-Level Move: From Free-Form Dictation to Structured Report

Dictating all the positive findings is one thing; structuring them perfectly under pressure is another. This is where AI-powered tools can significantly streamline your workflow. Instead of meticulously navigating a structured template, you can dictate your findings in a more natural, free-form paragraph. The software then parses your language and organizes it into a clean, comprehensive report.

Tools like GigHz Precision AI are designed for this. You dictate the positive findings—the LVEF, the LGE pattern, the presence of edema—and the platform generates a report using pre-loaded ACR and SIR templates. It’s designed to help you produce high-quality, attending-ready reports more efficiently, letting you focus on the diagnostic interpretation rather than the clerical task of formatting.

When Should You Order an MRI for Cardiac Function and Morphology? ACR Appropriateness Criteria

Cardiac MRI is a powerful tool, but it’s not always the first-line test. The American College of Radiology (ACR) provides evidence-based guidelines to help clinicians choose the right study for the right patient. For a comprehensive cardiac MRI, the ACR rates it as “Usually Appropriate” for a wide range of indications where echocardiography is insufficient.

For a patient with suspected or known heart failure or nonischemic myocardial disease (where ischemic causes have been excluded), cardiac MRI is a go-to for definitive characterization. This includes scenarios like suspected hypertrophic cardiomyopathy or suspected restrictive/infiltrative diseases like amyloidosis or sarcoidosis. It’s also the primary modality for evaluating cardiac masses identified on other studies.

In the realm of congenital heart disease, cardiac MRI is frequently “Usually Appropriate” for both pediatric and adult patients. This is especially true for complex cases where a complete assessment of morphology and function is needed after an initial echocardiogram. Key scenarios include follow-up of repaired Tetralogy of Fallot, evaluation after atrial or arterial switch procedures for transposition of the great arteries, and assessment of single ventricle physiology pre- and post-palliation. It is also the preferred next step for suspected aortic coarctation or anomalous pulmonary venous return when echo is inconclusive.

Key alternatives include echocardiography, which remains the first-line screening tool for most cardiac questions. For evaluating coronary anatomy, cardiac CT angiography (CCTA) is superior. For assessing the metabolic activity of inflammatory conditions like sarcoidosis, cardiac PET/CT is often used.

MRI Cardiac Function and Morphology Imaging Protocol — Phases, Contrast, and Key Parameters

A standard cardiac MRI protocol is a choreographed sequence of scans designed to capture function, flow, and tissue characteristics. The core of the exam involves ECG-gating to freeze cardiac motion and requires patient cooperation for multiple breath-holds. Gadolinium-based contrast is essential for perfusion and late-enhancement imaging.

The table below outlines a typical sequence of events for a comprehensive cardiac MRI. Specific parameters can vary by scanner and institution, but the fundamental components remain consistent.

Common protocol pitfalls: The most common challenges are poor ECG gating due to arrhythmia and patient inability to breath-hold, both of which cause significant motion artifact. For LGE imaging, incorrect selection of the inversion time (TI) can obscure or mimic enhancement, so it’s critical to ensure the normal myocardium is properly nulled (appears black).

The 3-Months-Free Offer for Radiology Residents and Fellows

3+ months free for radiology residents and fellows

Look like a rockstar on your reports. We’re offering an extended free trial of GigHz Precision AI specifically for trainees. You can dictate your positive findings in free form, and the AI will generate a structured report using ACR and SIR templates, firing the appropriate clinical decision support automatically. This is a great way to build confidence and efficiency on call and during daytime readouts.

All we ask in return is your feedback so we can keep improving the product for trainees. The signup is simple, with no credit card and no long forms. To get started, just provide these three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or specific fellowship)
3. Your training program / hospital name

Ready to give it a try? You can apply for the residents free-access program here.

Free GigHz Tools That Pair With This Article

Three free tools that complement the material above:

• ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
• GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
• GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.

Frequently Asked Questions

Is this tool HIPAA-compliant?

Yes. GigHz Precision AI is designed for de-identified workflows by default. No Protected Health Information (PHI) is required to use the tool to structure your findings, and no PHI is stored on our servers from your dictations.

Do I need our hospital’s IT department to set this up?

No. The platform is browser-based and requires no local software installation or special permissions from your IT department. It works on any modern web browser, including the one on your call-room computer or personal iPad.

Does it work with PowerScribe or other voice recognition software?

Yes, it works alongside your existing dictation system. You can dictate into PowerScribe as you normally would, then copy-paste your free-form text into the tool to generate the structured report. You then paste the final, clean report back into your PACS/RIS.

Can I use this on my phone or iPad?

Absolutely. The platform is fully responsive and works on mobile devices, making it easy to use on the go or on a tablet in the reading room.

Can I customize the templates?

Yes. While the system comes pre-loaded with standard ACR and society-based templates, you can create, save, and modify your own templates to match your personal preferences or your institution’s specific formatting requirements.

What happens after my residency or fellowship ends?

The free access is for trainees. After you graduate, you can choose to transition to a paid plan for practicing radiologists. We offer discounts for recent graduates to help with the transition into practice.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026