Acute chest pain with normal coronary angiogram: role of contrast-enhanced multidetector computed tomography in the differential diagnosis between myocarditis and myocardial infarction.
OBJECTIVE
To evaluate the accuracy of delayed-enhanced multidetector computed tomography (MSCT) for differentiating between myocarditis and myocardial infarction in patients with normal x-ray coronary angiography.


METHODS
Twelve consecutive patients referred for acute chest pain and normal coronary arteries on x-ray coronary angiography were involved in this study. Delayed-enhanced MSCT and postgadolinium delayed-enhanced magnetic resonance imaging (MRI) examinations were performed within 36 hours and 4 days, respectively, after patient admission. Comparison between delayed-enhanced MSCT and MRI was performed by 3 independent blinded observers in term of final diagnosis, number of involved segments, and transmural extent.


RESULTS
Final diagnosis between myocarditis and myocardial infarction was identical for delayed-enhanced MSCT and MRI with a significant agreement for number of involved segments and transmural extension. Interobserver reproducibility was good for both techniques.


CONCLUSIONS
We demonstrated that delayed-enhanced MSCT allows differentiation between myocardial infarction and myocarditis with the same accuracy at acute phase compared with MRI.
Boussel
Loic
L
Department of Radiology, University of California, San Francisco, CA, USA. loic.boussel@gmail.com
Gamondes
Delphine
D
Staat
Patrick
P
Elicker
Brett M
BM
Revel
Didier
D
Douek
Philippe
P
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology*; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007479:Iopamidol / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D009205:Myocarditis / Q000175:diagnosis*; D015588:Observer Variation; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*
D003287:Contrast Media; D009942:Organometallic Compounds; C057937:iomeprol; D008536:Meglumine; D007479:Iopamidol; C072417:gadoterate meglumine