Acute chest pain with normal coronary angiogram: role of contrast-enhanced multidetector computed tomography in the differential diagnosis between myocarditis and myocardial infarction

J Comput Assist Tomogr. Mar-Apr 2008;32(2):228-32. doi: 10.1097/RCT.0b013e3181452199.


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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Chest Pain / etiology*
  • Contrast Media / administration & dosage*
  • Coronary Angiography
  • Diagnosis, Differential
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Imaging, Three-Dimensional
  • Iopamidol / analogs & derivatives
  • Magnetic Resonance Imaging / methods
  • Male
  • Meglumine
  • Middle Aged
  • Myocardial Infarction / diagnosis*
  • Myocarditis / diagnosis*
  • Observer Variation
  • Organometallic Compounds
  • Predictive Value of Tests
  • Radiographic Image Enhancement / methods*
  • Reproducibility of Results
  • Tomography, X-Ray Computed / instrumentation
  • Tomography, X-Ray Computed / methods*


  • Contrast Media
  • Organometallic Compounds
  • iomeprol
  • Meglumine
  • Iopamidol
  • gadoterate meglumine