Acute Chest Pain With Normal Coronary Angiogram: Role of Contrast-Enhanced Multidetector Computed Tomography in the Differential Diagnosis Between Myocarditis and Myocardial Infarction

Loic Boussel, MD, Delphine Gamondes, MD, Patrick Staat, MD, Brett M. Elicker, MD, Didier Revel, MD, and Philippe Douek, MD, PhD

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 postgado-linium 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.