Cardiac magnetic resonance imaging of myocarditis and pericarditis following COVID-19 vaccination: a multicenter collection of 27 cases

Eur Radiol. 2022 Jul;32(7):4352-4360. doi: 10.1007/s00330-022-08566-0. Epub 2022 Mar 1.


Objectives: To assess clinical and cardiac magnetic resonance (CMR) imaging features of patients with peri-myocarditis following Coronavirus Disease 2019 (COVID-19) vaccination.

Methods: We retrospectively collected a case series of 27 patients who underwent CMR in the clinical suspect of heart inflammation following COVID-19 vaccination, from 16 large tertiary centers. Our patient's cohort was relatively young (36.6 ± 16.8 years), predominately included males (n = 25/27) with few comorbidities and covered a catchment area of approximately 8 million vaccinated patients.

Results: CMR revealed typical mid-subepicardial non-ischemic late gadolinium enhancement (LGE) in 23 cases and matched positively with CMR T2 criteria of myocarditis. In 7 cases, typical hallmarks of acute pericarditis were present. Short-term follow-up (median = 20 days) from presentation was uneventful for 25/27 patients and unavailable in two cases.

Conclusions: While establishing a causal relationship between peri-myocardial inflammation and vaccine administration can be challenging, our clinical experience suggests that CMR should be performed for diagnosis confirmation and to drive clinical decision-making and follow-up.

Key points: • Acute onset of dyspnea, palpitations, or acute and persisting chest pain after COVID-19 vaccination should raise the suspicion of possible myocarditis or pericarditis, and patients should seek immediate medical attention and treatment to help recovery and avoid complications. • In case of elevated troponin levels and/or relevant ECG changes, cardiac magnetic resonance should be considered as the best non-invasive diagnostic option to confirm the diagnosis of myocarditis or pericarditis and to drive clinical decision-making and follow-up.

Keywords: COVID-19; Magnetic resonance imaging; Myocarditis; Pericarditis; Vaccination.

Publication types

  • Multicenter Study

MeSH terms

  • Arrhythmias, Cardiac
  • COVID-19 Vaccines / adverse effects
  • COVID-19*
  • Contrast Media / pharmacology
  • Gadolinium / pharmacology
  • Humans
  • Inflammation
  • Magnetic Resonance Imaging
  • Male
  • Myocarditis* / diagnostic imaging
  • Myocarditis* / etiology
  • Pericarditis* / diagnostic imaging
  • Pericarditis* / etiology
  • Retrospective Studies
  • Vaccination


  • COVID-19 Vaccines
  • Contrast Media
  • Gadolinium