Imaging

Myocarditis

Preliminary Diagnosis: Myocarditis

I. What imaging technique is first-line for this diagnosis

  • PA and lateral view of the chest

II. Describe the advantages and disadvantages of this technique for diagnosis of myocarditis.

Advantages

  • Quick, relatively inexpensive modality

  • Exposes patients to negligible ionizing radiation

  • Highly portable

Disadvantages

  • Limited in sensitivity and specificity in detecting, diagnosing, and characterizing myocarditis

  • Limited in characterizing the surrounding soft tissues, osseous structures, and vasculature

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to plain radiography exist.

IV. What alternative imaging techniques are available?

  • Echocardiography

  • Cardiac MR

  • Cardiac CT

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of myocarditis.

Echocardiography

Advantages

  • Highly portable imaging modality

  • Does not expose patients to ionizing radiation

  • Highly sensitive and specific in detailing, diagnosing, and characterizing cardiac valvular structures

Disadvantages

  • Highly operator dependent

  • Limited in sensitivity and specificity in diagnosing myocarditis

Cardiac MR

Advantages

  • Highly sensitive and specific in diagnosing any inflammatory change or edema of the myocardium

  • Offers exquisite detail of the soft tissues

  • Gold standard in detecting inflammatory and/or infectious changes of the myocardium

  • Does not expose patients to ionizing radiation

Disadvantages

  • Limited in evaluating the surrounding osseous structures

  • May be subject to motion and susceptibility-weighted artifact degrading image quality

  • Expensive

Cardiac CT

Advantages

  • Quick imaging modality

  • Offers better detail of mineralized structures than other imaging modalities

Disadvantages

  • Limited in sensitivity and specificity in evaluating the surrounding soft tissues

  • Exposes patients to ionizing radiation

  • Limited in evaluating the surrounding soft tissues

VI. What are the contraindications for the alternative imaging techniques?

Echocardiography

  • No specific contraindications to echocardiography exist.

Cardiac MR

  • Contraindicated in patients with non–MR-compatible hardware

Cardiac CT

  • May be contraindicated in patients who are pregnant

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