Cardiac MRI for four children with clinical diagnosis of acute myocarditis in the setting of COVID-19–related Kawasaki-like symptoms of MIS-C. The top panel demonstrates minimal pericardial effusion on cine images. The second panel demonstrates increased T2-STIR signal intensity with average ratios between myocardium and muscle > 2 in patient 2 (12-year-old male), patient 3 (11-year-old female) and patient 4 (6-year-old female). The third panel demonstrates abnormal native-T1 mapping, which was > 1,100 ms in patients 2, 3 and 4 and normal in patient 1 (8-year-old female). The bottom panel demonstrates absence of late gadolinium enhancement (LGE) in patients 2 and 3. Myocardial null times were recognized as too short in patient 4 but could not be repeated due to lack of further patient cooperation; however review of Look Locker images and additional sequences revealed no LGE. Image courtesy of RSNA.

Photo copyright American Heart Association, used with permission.