**5. Conclusion**

*Inflammatory Heart Diseases*

**myocarditis and pericarditis**

probability rate (**Figure 7**) [59].

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].

**4. Using cardiovascular magnetic resonance (CMR) in the assessment of** 

Recently, CMR has become a crucial tool for acute myocardial tissue damage. In Europe, CMR represents the differential diagnosis of 1/3 of the cardiac cases [55]. CMR is used to detect the features of myocarditis edema and is related with pericardial fluids, which might be visualized together in images. CMR enables the evaluation of myocardial fluid accumulation and infection process. The CMR gives high accuracy and recognition of the acute inflammatory process, regardless of image quality differences due to the scanner and applied procedure [56, 57]. CMR might detect the accumulation of fluids which represents [58]. The body coil might help in the reduction of acquiesced signal noise, signal scattering, flow suppression, suitable slice width, and sufficient scanning time. Sixteen short-axis views are suggested to decrease the artifacts associated with the sluggish transplanar blood stream. In females, the mild edema is scanned using the signal that normalizes to skeletal muscle in similar slice. The gadolinium (Gd) might increase the recognition of the myocarditis edema especially after using contrast media-sensitive sequence and T1-weighted image. The comparison between the signals, prior and throughout the contrast-enhanced scanning, might show the large volume of edema. Consequently, using the adjacent muscle as reference helps in detecting of the edema area [61–63]. Recently, many studies showed that using Lake Louise criteria does not affect the diagnosis, but they increase the possibilities of the false-positive

Other studies showed that an amplified Gd enhancement ratio of more than 4.0 is related to patient complications and disease prognosis [60]. T2-weighted images might be used to detect myocardial edema, which indicates the presence of myocarditis. This technique had shown high precision and accuracy. The patients'

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**Figure 7.**

*Shows cardiovascular magnetic resonance of the pericardium.*

Myocardium inflammation is considered as a serious condition that affects both pediatric and adult patients with fetal consequences disease. The chronic myocardial inflammation might eventually lead to cardiac failure. Recently, the evolution in tools of diagnosis, screening, and treatment might decrease the morbidity rate of myocarditis and pericarditis.

About 10% of myocarditis has been discovered in autopsy. Many studies had shown that the best modality to diagnose the myocarditis is a biopsy. Many imaging techniques might be used to diagnose myocarditis and pericarditis; nevertheless, the CMR is the most crucial and precise analytical modality. CMR might help in differentiating between the myocardial infraction, inflammation, and injuries and the degree of severity. The fluoroscopic endomyocardial procedures have low complications compared with other invasive tools. The advance CMR protocols are used to improve the diagnosis and reduce the morbidity.
