2009

Cardiac magnetic resonance imaging (cMRI or CMR) has been shown to be very useful in diagnosing myocarditis by visualizing markers for inflammation of the myocardium. Cardiac MRI is most sensitive when performed 2–3 weeks after the initial clinical presentation of myocarditis and may be repeated 6–12 months after onset to monitor the evolution of disease or response to treatment. The Lake Louise Criteria (established in 2009) are a commonly used MRI criteria to establish the diagnosis of myocarditis in suspected cases. The Lake Louise Criteria include increased signal intensity after gadolinium contrast enhancement (a sign of hyperemia, or increased blood flow to damaged tissue), increased myocardial T2 relaxation time or an increased T2 signal intensity (which are signs of tissue edema or swelling), and late gadolinium contrast enhancement (which is a sign of tissue necrosis (tissue damage) or fibrosis (scarring)). In 2018, additional radiographic MRI criteria were added, including increased T1 signal intensity and increased extracellular volume (both of which being signs of myocardial injury). The original 2009 Lake Louise Criteria had a 74% sensitivity and 86% specificity in the diagnosis of myocarditis, but when adding the 2018 update to the criteria (in which T1 signal intensity was found to have high diagnostic sensitivity), the sensitivity and specificity in the diagnosis of myocarditis increased to 88% and 96% respectively. Cardiac MRI, if available, is recommended in all cases of suspected myocarditis.

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