New imaging methods in assessing the pediatric patient with suspected myocarditis

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Due to the variability of the clinical presentation, acute myo­car­di­tis is an underdiagnosed pathology. The importance of this pathology derives from the need to establish the diag­no­sis as early as possible, in order to establish an adap­ted therapeutic strategy and to avoid the occurrence of complications. Acute myocarditis is one of the causes of sud­den death in infants and children. The most common cause is viral etiology. Myocarditis should be suspected in all children who have precordial pain associated with in­creased cardiac enzymes and a history of viral infection. The current gold standard for diagnosis is endomyocardial biop­sy, but this investigation cannot be performed routinely. Car­diac magnetic resonance imaging has become an im­por­tant tool for the noninvasive diagnosis of acute myo­car­di­tis, being performed after an well-established pro­to­col, ac­cor­ding to the Lake Louise criteria. With the help of cardiac mag­ne­tic resonance imaging there can be detected multiple path­olo­gies, but for establishing the diag­no­sis of myocarditis and of the alterations associated with this pathology, the location and extent of edema, the hyperemia, inflammation and fi­bro­sis, the presence of seg­men­tal or global wall-motion ab­nor­ma­li­ties, pericardial ef­fu­sion, the size of interventricular sep­tum and of ventricle free wall, the ventricle diameter, right and left ventricle func­tions, along with atrioventricular and ven­tri­cu­lo­ar­te­rial con­cor­dance are of paramount im­por­tance. New mapping tech­niques are particularly useful in myo­car­di­tis due to their abi­li­ty to quantify focal and diffuse changes.