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Noninvasive imaging in acute myocarditis

Bami, Karan; Haddad, Tony; Dick, Alexander; Dennie, Carole; Dwivedi, Girish

Current Opinion in Cardiology: March 2016 - Volume 31 - Issue 2 - p 217–223
doi: 10.1097/HCO.0000000000000265
HEART FAILURE: Edited by Haissam Haddad
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Purpose of review The gold standard for diagnosing acute myocarditis is endomyocardial biopsy, but it is highly invasive and can result in serious complications. Noninvasive imaging has an essential role in the management of suspected acute myocarditis. In this article, we aim to review the role of various imaging techniques in acute myocarditis.

Recent findings Newer methods such as strain and strain rate imaging using speckle tracking have emerged as an adjunctive echocardiographic parameter of myocardial dysfunction. The latest advancements in cardiovascular magnetic resonance (CMR) techniques have allowed quantitative T1 and T2 mappings that aim to quantify the areas of edematous myocardium and also address some of the limitations of traditional techniques as viable tools. An automated method for calculating late gadolinium enhancement by CMR has been developed in recent years. 18-Fluorodeoxyglucose PET is increasingly being used to assist in the diagnosis of myocarditis associated with cardiac sarcoidosis.

Summary Echocardiography remains an essential and most commonly used initial investigation in suspected myocarditis. Due to the recent technological hardware and software advancements in CMR technology, CMR continues to occupy a pole position amongst all the other imaging modalities. The utility of cardiac computed tomography is less clear.

aDepartment of Medicine (Cardiology), University of Ottawa Heart Institute

bDepartment of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Canada

Correspondence to Girish Dwivedi, MD, PhD, MRCP (UK), FASE, Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. Tel: +001 6137615046; fax: +001 6137615039; e-mail: gdwivedi@ottawaheart.ca

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