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 multi-detector 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.