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Canadian Journal of Cardiology

Spectral Contrast-Enhanced Cardiac Computed Tomography for Diagnosis of Acute Myocarditis

Published:December 24, 2014DOI:https://doi.org/10.1016/j.cjca.2014.12.022
      A 62-year-old male patient was admitted for acute chest pain with elevated levels of troponin I (4.5 μg/L; normal range, < 0.05 μg/L), and no significant abnormalities on his electrocardiogram. Transthoracic echocardiographic results were normal. Contrast-enhanced electrocardiographic gated 64-row multislice computed tomography (CT) showed normal coronary arteries, and first-pass imaging demonstrated normal myocardial perfusion. A delayed iodine contrast-enhanced computed tomographic scan using a spectral technique performed 5 minutes after injection showed a limited subepicardial delayed enhancement of the inferolateral wall at the mid–left ventricle, suggesting the diagnosis of focal myocarditis (Fig. 1, A and B). Magnetic resonance imaging (MRI) confirmed the diagnosis of myocarditis and showed a hypersignal on the T2-weighted sequence and on delayed enhancement consistent with the edema appearing in acute myocarditis. There was an anatomic match of the CT and MRI findings (Fig. 1C). The acute phase of the inflammation was affirmed by the edema as seen on the T2-weighted image. The patient was discharged after clinical improvement and a decrease in troponin levels and was treated with aspirin for 3 weeks.
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      Figure 1(A) Five-cavity, 2-cavity, and short-axis views on cardiac computed tomography (CT) showing normal perfusion of the myocardium. (B) Five-cavity, 2-cavity, and short-axis views on cardiac spectral CT; note the focal subepicardial delayed enhancement (white arrows) on the iodine mapping imaging, attesting to the increased uptake of iodine contrast agent in the interstitial tissue of the inflamed myocardium. (C) Five-cavity, 2-cavity, and short-axis views on cardiac magnetic resonance imaging; confirmed delayed-enhancement findings seen on spectral CT with better contrast but with an excellent topographic match, involving the subepicardial and intramural delayed hyperenhancement (white arrows).
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