Unusual Cause of Mid Myocardial Late Gadolinium Enhancement at Cardiac MRI.

Cardiac MRI is the reference standard for identifying and evaluating myocardial pathologic conditions. Late gadolinium enhancement characteristics provide an excellent guide in classifying disease and triaging patients. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an uncommon congenital anomaly. Myocardial enhancement at cardiac MRI is often a sign of a myocardial pathologic condition, while more specifically, subendocardial enhancement is a feature expected in patients with ALCAPA. This report describes the atypical finding of mid myocardial late gadolinium enhancement in three adult patients with ALCAPA. Keywords: Mid Myocardial Enhancement, Cardiac MRI, Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery © RSNA, 2025.