Cardiac Magnetic Resonance Imaging in Immune Checkpoint Inhibitor-Myocarditis: Diagnostic and Prognostic Evidence and...

Immune checkpoint inhibitor (ICI)-associated myocarditis (ICI-M) is rare but often severe. Cardiac magnetic resonance imaging (CMR) can detect myocardial edema and injury as well as fibrosis, yet its role in the setting of ICI-M remains uncertain. This review evaluates recent evidence on CMR findings, prognostic markers, and practical limitations in ICI-M.

T1/T2 mapping and strain analysis may detect myocardial involvement not evident with conventional measures, but sensitivity is variable and affected by scan timing, prior therapies, and protocol heterogeneity. Prognostic associations have been reported for elevated native myocardial T1, septal late gadolinium enhancement (LGE), and impaired strain, though not consistently. In oncology patients, interpretation is further complicated by potential baseline myocardial abnormalities. While CMR can contribute to the diagnostic work-up and risk assessment of ICI-M, current evidence is inconsistent and hampered by methodological limitations. CMR should be timely and findings should be interpreted alongside clinical, biological, ECG, echocardiographic and pathology data. Standardized multicenter prospective studies are needed.