Cardiovascular Magnetic Resonance in Myocarditis

Abstract

Myocarditis is an inflammatory disease of the myocardium, and its diagnosis remains challenging owing to a varying clinical presentation and broad spectrum of underlying aetiologies. In clinical practice, cardiovascular magnetic resonance has become an invaluable non-invasive imaging tool in the evaluation of patients with clinically suspected myocarditis, mainly thanks to its unique multiparametric tissue characterization ability. Although considered as useful, the method also has its limitations. This review aims to provide an up-to-date overview of the strengths and weaknesses of cardiovascular magnetic resonance in the diagnostic work-up of patients with clinically suspected myocarditis in a broad clinical context.

Keywords: inflammatory cardiomyopathy; magnetic resonance imaging; myocarditis.

Figure 1

Native T1 map (left) in a patient with acute myocarditis showing prolonged T1 relaxation times in the anterolateral and inferoseptal regions of the left ventricle (1320 ± 43 ms (local reference 999 ± 31 ms)). Corresponding T2-weighted black blood short tau inversion recovery sequence (right) with clear signs of oedema in the same regions.

Figure 2

Characteristic late gadolinium enhancement (LGE) patterns in viral myocarditis (upper left, inferolateral subepicardial LGE), giant cell myocarditis (upper right, complex LGE involving both ventricles including the right ventricular insertion points), cardiac sarcoidosis (lower left, complex LGE involving both ventricles including the inferior right ventricular insertion point), and eosinophilic myocarditis (lower right, diffuse subendocardial LGE with high signal intensity).