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

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

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'

**131**

*Application of Medical Imaging in Diagnosis and Assessment of Myocarditis and Pericarditis*

movements and image artifacts affect the quality of the images. The new scanning protocol overcomes those problems by using the short acquisition time [61–63].

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

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

The authors are thankful to the Deanship of Scientific Research, at Majmaah

\* and Nouf H. Abuhadi2

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 Radiological Science and Medical Imaging Department, College of Applied

2 Diagnostic Radiology Department, College of Applied Medical Science,

Medical Science, Majmaah University, Majmaah, Saudi Arabia

\*Address all correspondence to: y.yousif@mu.edu.sa

used to improve the diagnosis and reduce the morbidity.

*DOI: http://dx.doi.org/10.5772/intechopen.87218*

**5. Conclusion**

myocarditis and pericarditis.

**Acknowledgements**

**Conflict of interest**

**Author details**

Yousif Mohamed Y. Abdallah1

Jazan University, Jazan, Saudi Arabia

provided the original work is properly cited.

University, for funding this research.

There are no conflicts of interest.

**Figure 7.** *Shows cardiovascular magnetic resonance of the pericardium.*

*Application of Medical Imaging in Diagnosis and Assessment of Myocarditis and Pericarditis DOI: http://dx.doi.org/10.5772/intechopen.87218*

movements and image artifacts affect the quality of the images. The new scanning protocol overcomes those problems by using the short acquisition time [61–63].
