Table 2.

Non-invasive imaging in the diagnosis of myocarditis

Imaging modalities	Strengths	Limitations	Reccomandation during COVID-19 pandemic
Echocardiography	Safe Versatile Widely available technique No radiation exposure or use of contrast	Inadequate soft tissue characterization Poor acoustic windows Inter-observer variability Highly variable echocardiographic findings in myocarditis	Bedside echocardiography should be the first modalities in symptomatic COVID-19 patients with altered cardiac enzyme biomarker
CCT	High spatial resolution Tissue characterization	Radiation exposure Contrast medium reactions	Useful of CCT with late iodine enhance scan
CMR	Tissue characterization High spatial and temporal resolution Excellent reproducibility No radiation exposure	Low availability Costs Intrinsic or extrinsic factors of the patient (claustrophobia,metallic implants, allergy, ability to hold breath and arrhythmia) Long scan times	Main role in management of suspected myocarditis to confirm the diagnosis with fast CMR protocol
Nuclear medicine techniques	Marker of myocardial inflammation and necrosis	Limited specificity Cost Limited availability Radiation exposure	Not useful
Chest X ray	Indirect sign	Low sensitivity Very low specificity	Portable x-ray should be the first line modalities in asymptomatic and minimally symptomatic COVID-19 patients to have insight at the same time about lung and heart