Background-Aim. Accurate diagnosis of cardiovascular involvement in connective tissue diseases (CTD) remains challenging. We hypothesized that cardiovascular magnetic resonance (CMR) demonstrates cardiac lesions in symptomatic CTDs with normal echochardiography. Patients-Methods. CMR from 246 CTDs with typical (TCS) (n=146, group A) or atypical (ATCS) (n=100, group B) cardiac symptoms were retrospectively evaluated. Group A included 9 inflammatory myopathies (IM), 35 sarcoidosis (SRC), 30 systemic sclerosis (SSc), 14 systemic lupus erythematosus (SLE), 10 rheumatoid arthritis (RA) and 48 small vessel vasculitis. Group B included 25 RA, 20 SLE, 20 SRC, 15 SSc, 10 IM and 10 small vessel vasculitis. CMR was performed by 1.5 T; LV ejection fraction, T2 ratio (oedema imaging) and late gadolinium enhancement (LGE) (fibrosis imaging) were evaluated. Acute and chronic lesions were characterised as LGE-positive plus T2>2 or T2