**3.4 Nuclear medicine**

*Inflammatory Heart Diseases*

Those stages are:

**Stage 3:** T-wave inversions.

*Shows the ECG scan of myocarditis and pericarditis.*

**Stage 4:** standardization of ECG [46, 47].

segment.

**Figure 3.**

**3.2 Chest X-ray**

**Stage 1**: (hours to a few days): the ST elevation and depression of the PR

Chest radiograph is a radiographic procedure that uses low-energy ionizing radiation (X-rays) to visualize the chest organs. This procedure is very crucial in the assessment of lung and heart signs and symptoms such as cough, chest infection, injury, and discomfort [48]. This procedure is used to evaluate and screen heart inflammatory diseases such as myocarditis and pericarditis. This procedure is noninvasive and does not require special patient preparation. Chest radiography is a standard procedure for myocarditis and pericarditis patients. A distended cardiac shadow might be identified with accumulated fluids. Chest X-ray shows cardiac enlargement as a result of chamber dilatation, pericardial effusion, interstitial infiltrates, and pleural effusions (**Figure4**) [49–51].

**Stage 2**: (first week): control of the ST and PR segments.

**128**

**Figure 4.**

*Shows chest radiograph of myocarditis patient.*

FDG PET-CT can be used for visualization of myocarditis and pericarditis. This technique helps to differentiate between the acute and chronic cardiomyopathy diseases. Recently PET/MRI is used for detecting myocarditis and pericarditis [53]. The evaluation of myocarditis using nuclear scanning had started in the early 1970s. This scanning technique had started by using gallium-67 to visualize the internal

**Figure 6.** *Shows the nuclear medicine image of myocarditis.*

muscles of the heart. In the early 1980s, the utilization of SPECT enhanced the results of detection of the myocardial tissues. So the detection of the myocarditis and pericarditis became easier than using planar scanner. The radioiodine-labeled (I-111) was introduced in the 1970s. This radioactive test was used to detect monoclonal antimyosin antibodies because of its ability to detect the necrotic area (**Figure 6**) [54].
