Figure 4: A 55-year-old male known diabetic had dyspnea on exertion class III. ECG was suggestive of anterior wall MI. Cardiac MRI was performed for the assessment of myocardial viability. (a) Precontrast 2C cine diastolic image showing dilated LV with globular morphology (dashed yellow line). Apparent thickening along the anterior wall (black arrow) was also noted. (b) 2C LGE demonstrating nonenhancing layered thrombus along the anterior wall (black arrow). Note the transmural LGE along the anterior and inferior walls and LV apex. (c) Short-axis cine images acquired after administration of Gd contrast showed nonenhancing thrombus (asterisk) along the anterior wall as compared with the enhancing myocardium. Excellent contrast between the thrombus and myocardium is achieved following contrast administration. Compare this with precontrast cine in a. (d) Short-axis LGE image shows near-circumferential ischemic scar and nonenhancing thrombus along the anterior wall (asterisk). Final diagnosis: Multivessel ischemic heart disease with a layered mural clot. 2C: Two-chamber, ECG: Electrocardiogram, Gd: Gadolinium, LGE: Late gadolinium enhancement, LV: Left ventricle, MI: Myocardial infarction, MRI: Magnetic resonance imaging