Cardiac magnetic resonance imaging: diagnostic value and utility in the follow-up of patients with acute myocarditis mimicking myocardial infarction.
OBJECTIVE
The aim of our study was to evaluate the efficacy of magnetic resonance imaging (MRI) in the differential diagnosis between active myocarditis and myocardial infarction in patients with clinical symptoms mimicking acute myocardial infarction.


METHODS
Between 1 January 2006 and 30 June 2007, 23 consecutive patients (21 men and 2 women) presenting with electrocardiographic abnormalities mimicking acute myocardial infarction and a clinical suspicion of acute myocarditis (fever, chest pain and elevated troponin levels) underwent contrast-enhanced cardiac MRI within a week of admission. All patients also underwent coronary angiography, which demonstrated the absence of significant coronary artery lesions. The mean follow-up period was 2+/-4 months.


RESULTS
Cardiac MRI with injection of contrast material showed late subepicardial and intramyocardial enhancement in all patients. Subendocardial late enhancement, a typical pattern of myocardial infarction, was never seen. In addition, in agreement with the literature, there was prevalent involvement of the lateral segments of the left ventricular wall.


CONCLUSIONS
Cardiac MRI could be a valuable tool for the early diagnosis of acute myocarditis, as it can demonstrate specific patterns that help rule out acute myocardial infarction.
Danti
M
M
U.O.C. di Radiodiagnostica, Ospedale M.G.Vannini, Via Dell'Acqua Bullicante 4, Roma, Italy. radiologiadiagnostica@mgvannini.com
Sbarbati
S
S
Alsadi
N
N
Di Filippo
A
A
Gangitano
G
G
Giglio
L
L
Salvini
V
V
Amoruso
M
M
Camastra
G S
GS
Ansalone
G
G
Della Sala
S
S
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D009205:Myocarditis / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
D003287:Contrast Media