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STATE-OF-THE-ART PAPER

Noninvasive Imaging in Myocarditis

Hadi N. Skouri, MD^_*, G. William Dec, MD, FACC, Matthias G. Friedrich, MD, FESC and Leslie T. Cooper, MD, FACC^_*,_*

^_* Cardiovascular Department, Mayo Clinic, Rochester, Minnesota
Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
Stephenson CMR Centre, University of Calgary, Calgary, Alberta, Canada.

Manuscript received March 1, 2006; revised manuscript received July 5, 2006, accepted July 5, 2006.

^_* Reprint requests and correspondence: Dr. Leslie T. Cooper, Jr., Mayo Clinic, 5 Gonda, 200 First Street SW, Rochester, Minnesota 55905. (Email: Cooper.leslie{at}mayo.edu).

Increased recognition of the role of inflammation in acute and chronic dilated cardiomyopathy has revived an interest in noninvasive imaging for detection of myocarditis. Diagnostic strategies that are based on molecular imaging promise to further advance our understanding and improve diagnostic precision. This article reviews the strengths and limitations of common clinical tests used for the diagnosis of myocarditis, with a focus on the emerging role of cardiovascular magnetic resonance imaging. Novel imaging modalities that are currently in preclinical development are discussed with recommendations for future clinical research.

Abbreviations and Acronyms   AM = antimyosin   AMI = acute myocardial infarction   CMR = cardiac magnetic resonance   DCM = dilated cardiomyopathy   EMB = endomyocardial biopsy   FM = fulminant myocarditis   H/L = heart-to-lung ratio   LE = late enhancement   LGE = late gadolinium enhancement   LV = left ventricle/ventricular   RVSF = right ventricular systolic function   TD = tissue Doppler   USPIO = ultrasmall superparamagnetic iron oxide

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