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.

Key Points:

• Different imaging modalities are increasingly used in the diagnostic workup of myocarditis.

• Several emerging imaging techniques are currently on the way to becoming part of the clinical routine.

• This review summarizes the diagnostic value of echocardiography, CMR, CT, and nuclear medicine imaging.

• There is special focus on the possibilities and challenges of novel imaging tools within the different modalities.

Citation Format:

• Baeßler B, Schmidt M, Lücke C et al. Modern Imaging of Myocarditis: Possibilities and Challenges. Fortschr Röntgenstr 2016; 188: 915 – 925

Zusammenfassung

Die Myokarditis ist bekannt als das Chamäleon unter den kardiologischen Erkrankungen: ihre Symptomatik ebenso wie ihr klinischer Verlauf variieren stark, was die Diagnosestellung zu einer großen Herausforderung macht. Eine frühzeitige und korrekte Diagnosestellung ist jedoch von großer Bedeutung, da die Myokarditis eine der Hauptursachen für den plötzlichen Herztod bei jungen Erwachsenen darstellt und nicht selten in einer dilatativen Kardiomyopathie mündet. Aufgrund der Limitationen der routinemäßig eingesetzten diagnostischen Verfahren (bestehend aus Anamnese, klinischer Untersuchung, Blutuntersuchungen und Elektrokardiogramm) sind unterschiedliche bildgebende Verfahren in den letzten Jahrzehnten unverzichtbar für die nicht-invasive Diagnostik der Myokarditis geworden. Ziel der vorliegenden Übersichtsarbeit ist es deshalb, den derzeitigen Stand der Technik in der Diagnostik der Myokarditis über sämtliche bildgebende Modalitäten (Echokardiografie, kardiale Magnetresonanztomografie, kardiale Computertomografie, nuklearmedizinische Untersuchungstechniken) zusammenzufassen und anschließend einen Einblick in junge, noch nicht vollständig klinisch etablierte Techniken zu geben, welche sich in der näheren Zukunft als nützlich im Hinblick auf eine einfachere und genauere Diagnose dieser relevanten Erkrankung erweisen könnten.

Key Points:

• Verschiedene bildgebende Verfahren spielen eine zunehmend wichtigere Rolle in der Diagnostik der Myokarditis.

• Einige neue Bildgebungs-Techniken befinden sich derzeit bereits auf dem Weg in die klinische Routine.

• Dieser Übersichtsartikel gibt einen Überblick über die diagnostische Wertigkeit der Echokardiographie, der kardialen MRT und CT sowie nuklearmedizinischer Verfahren.

Ein spezieller Fokus liegt hierbei auf den Möglichkeiten und Herausforderungen neuer Bildgebungs-Techniken innerhalb der verschiedenen Modalitäten.

Key words

cardiac - inflammation - MR imaging - myocarditis - cardiac MRI

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