Cardiac mri assessment of nonischemic myocardial inflammation: State of the art review and update on myocarditis associated with covid-19 vaccination

Abstract

Myocarditis is a nonischemic inflammatory disease of the myocardium that can be triggered by a multitude of events, including viral infection and toxins. Recently, there has been heightened interest in myocarditis given its association with COVID-19 vaccination. Timely identification of myocarditis can affect patient management and prognosis. Therefore, it is crucial for radiologists and cardiac imagers to understand the role of cardiac imaging to establish a diagnosis and inform treatment decisions. Cardiac MRI is the most important noninvasive imaging modality for evaluation of myocarditis with typical findings of focal or diffuse myocardial edema and myocardial damage, including presence of late gadolinium enhancement. There is currently limited data available to indicate that the pattern of myocardial injury following COVID-19 vaccination is similar to other causes of myocarditis, although the severity of disease may be relatively mild. A description of the role of imaging and typical imaging features will be reviewed here with a focus on emerging data in the setting of myocarditis after COVID-19 vaccination.