Multimodality Imaging in Myocarditis: Integrating Etiology, Diagnosis, and Risk Stratification

Myocarditis presents with heterogenous clinical manifestations and remains diagnostically challenging due to nonspecific biomarkers and limitations of endomyocardial biopsy. This review evaluates the role of multimodality cardiac imaging in the diagnosis, phenotyping, and longitudinal management of myocarditis, and proposes a practical clinical integration pathway.

Cardiac magnetic resonance has emerged as the reference noninvasive modality, with parametric mapping and updated Lake Louise Criteria improving diagnostic sensitivity and prognostic stratification. Echocardiographic strain imaging enhances detection of subclinical dysfunction. Positron emission tomography enables assessment of active inflammation, particularly in sarcoidosis and immune checkpoint inhibitor-associated myocarditis. Advances in photon-counting CT, hybrid PET/MR, and artificial intelligence are expanding tissue characterization and risk prediction capabilities. A stepwise imaging strategy integrating echocardiography, CMR, PET, and CT improves diagnostic confidence and guides tailored management. Ongoing research focused on imaging biomarker standardization, validation, and outcome prediction will further refine precision care in myocarditis.