Modern Imaging of Myocarditis: Possibilities and Challenges

Abstract

▼Myocarditis is known as the chameleon of cardiac diseases. The symptoms and the course of disease vary greatly so that it is often challenging to establish a diagnosis. Early and accurate diagnosis is of utmost importance, since myocarditis is one of the leading causes of sudden cardiac death in young adults and represents an important precursor to dilated cardiomyopathy. Due to the constraints of the routinely used diagnostic approach, including clinical history and examination, laboratory testing, and electrocardiogram, different imaging modalities have emerged over the last decades as contributors to the noninvasive diagnosis of myocarditis. With this interdisciplinary review we would like to present the current state-of-the-art imaging of myocarditis across all available imaging modalities (i. e., echocardiography, cardiac magnetic resonance, cardiac computed tomography, and nuclear medicine). Furthermore, we present novel imaging techniques that might become useful in the near future for easier and more accurate diagnosis of this highly relevant disease.

Diretriz de Miocardites da Sociedade Brasileira de Cardiologia – 2022

“…A aquisição tardia de angio-TC é realizada 3 a 5 minutos mais tarde, sem necessidade de reinjeção do meio de contraste, permitindo a captação de iodo em imagens tardias com contraste realçados de maneira semelhante à RM do coração. 140,141 A angio-TC e a RM do coração têm maneiras próprias e exclusivas de evitar uma angiografia coronariana invasiva, para excluir DAC (significativa) e para detectar outras doenças, como dissecção aguda da aorta, embolia pulmonar, miocardite ou cardiomiopatia de estresse. 142 A grande disponibilidade da angio-TC, combinada com a possibilidade de descartar síndrome coronariana aguda (SCA) com angiografia coronariana durante o mesmo exame, torna-a promissora no refinamento das imagens de miocardite aguda (Tabela 11).…”

Epicardial Adipose Tissue and Renal Disease

“…Echocardiography, computed tomography (CT), or magnetic resonance imaging (MRI) are the three methods that are used to measure and quantify EAT [5,8]. Various advantages and disadvantages of these three modalities are given in Table 1 [1,33,34,35,36,37,38,39]. Echocardiography is a simple, inexpensive, and readily available in health care facilities; however, with high intra- and inter-observer variability, inability to quantify the epicardial fat, and at times overestimation of EAT are some of its significant drawbacks.…”

MRI in patients with pacemakers?First global consensus recommendationsfrom radiologists and cardiologists

“…In Germany and internationally the number of MRI examinations is increasing: 1,008,944 examinations were performed on patients receiving inpatient treatment in 2005 while 1,767,005 examinations were performed in 2013 (DRG hospitals). This development can be attributed to our aging population as well as to new indications for MRI including: Analyses of tissue composition and function, for example in the liver [3,4] and the heart [5,6]; multiparametric analyses of MR perfusion, e. g. in treated brain tumors [7]; new organs such as the lung [8]; dedicated examinations for intervention planning and operation monitoring [9 -11]; as well as MRI-guided interventions [12 -16].…”