Matsuki and Matsuo21pointed out the usefulness of MRI in diagnosing and monitoring patients with cardiac sarcoidosis. Granulomatous infiltrates appear on MRI images as areas of increased signal density. T2-weighted images tend to produce a more pronounced signal because of the associated edema. These images can be enhanced with gadolinium diethylenetriamine pentaacetic acid.22–23 The accurate localization of a granulomatous lesion by MRI can be used as a guide to obtaining an endomyocardial biopsy specimen.21 In the December 2002 issue of CHEST, Vignaux and associates,24used MRI as a method of evaluating and monitoring cardiac sarcoidosis in 12 sarcoidosis patients. All patients had undergone extensive cardiac evaluations, including an ECG, 24-h Holter monitoring, echocardiography, 201Tl imaging, cardiac MRI, and coronary angiography, if indicated. An endomyocardial biopsy specimen was not obtained in any patient. MRI abnormalities, consisting of cardiac signal intensity and thickness, were grouped in the following three patterns: nodular; focal increase in signal on gadolinium diethylenetriamine pentaacetic acid-enhanced, T1-weighted images; and focal increased signal on T2-weighted images without gadolinium uptake. The MRI images that were obtained initially and at the 12-month follow-up interval were interpreted by two independent cardiovascular radiologists. Scores ranging from −1 to +1 were assigned to six different myocardial areas. The improvement or stability of the MRI findings was correlated with clinical features. In six patients who had received corticosteroid therapy, the MRI images improved either partially or completely, whereas, the images from the patients who had received no corticosteroid therapy either worsened or remained unchanged. The study is small and lacks a correlation of myocardial histology with MRI features. However, the study clearly calls for a large multicenter trial. The cardiac MRI may find its usefulness as a guide to obtaining endomyocardial biopsy specimens and to monitoring the response of the disease to treatment. The most significant drawback of MRI is that the patient with a pacemaker and/or automatic implantable cardioverter defibrillator will not be able to take advantage of it. In such patients, 201Tl scanning remains the test for assessing myocardial damage. An endomyocardial biopsy is preferable, but the procedure has a sensitivity as low as 20%.25 Thus, the search for a safe, reliable, and easily available diagnostic test for cardiac sarcoidosis continues.