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

Emanuele Angelo Di Dedda, Andrea Barison, Giovanni Donato Aquaro, Tevfik F. Ismail, Alina Hua, Cesare Mantini, Fabrizio Ricci, Gianluca Pontone, Alessandra Volpe, Francesco Secchi, Paolo Di Renzi, Luigi Lovato, Fabio Niro, Carlo Liguori, Chiara De Biase, Lorenzo Monti, Antonio Cirò, Riccardo Marano, Luigi Natale, Eleonora MoliternoAntonio Esposito, Davide Vignale, Riccardo Faletti, Marco Gatti, Michele Porcu, Luca Saba, Cristina Chimenti, Nicola Galea, Marco Francone*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)4352-4360
Number of pages9
JournalEuropean Radiology
Issue number7
Early online date1 Mar 2022
Publication statusPublished - 1 Jul 2022


  • COVID-19
  • Magnetic resonance imaging
  • Myocarditis
  • Pericarditis
  • Vaccination


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