A stepwise multimodality imaging strategy integrating echocardiography, CMR, PET, and CT improves diagnostic confidence and guides tailored management in patients with myocarditis.
What is the role of multimodality cardiac imaging in the diagnosis, phenotyping, and management of myocarditis?
This review highlights the critical role of integrating multimodality imaging, particularly CMR and PET, to improve diagnostic accuracy and risk stratification in patients with myocarditis.
Purpose of Review Myocarditis presents with heterogenous clinical manifestations and remains diagnostically challenging due to nonspecific biomarkers and limitations of endomyocardial biopsy. This review evaluates the role of multimodality cardiac imaging in the diagnosis, phenotyping, and longitudinal management of myocarditis, and proposes a practical clinical integration pathway. Recent Findings Cardiac magnetic resonance has emerged as the reference noninvasive modality, with parametric mapping and updated Lake Louise Criteria improving diagnostic sensitivity and prognostic stratification. Echocardiographic strain imaging enhances detection of subclinical dysfunction. Positron emission tomography enables assessment of active inflammation, particularly in sarcoidosis and immune checkpoint inhibitor-associated myocarditis. Advances in photon-counting CT, hybrid PET/MR, and artificial intelligence are expanding tissue characterization and risk prediction capabilities. Summary A stepwise imaging strategy integrating echocardiography, CMR, PET, and CT improves diagnostic confidence and guides tailored management. Ongoing research focused on imaging biomarker standardization, validation, and outcome prediction will further refine precision care in myocarditis.
Debs et al. (2026) conducted a review in Myocarditis. Multimodality cardiac imaging was evaluated. A stepwise multimodality imaging strategy integrating echocardiography, CMR, PET, and CT improves diagnostic confidence and guides tailored management in patients with myocarditis.