Cardiovascular Images Acute Myocarditis Demonstrated on CT Coronary Angiography With MRI Correlation

Acute myocarditis often is demonstrated on cardiac MRI (CMR) as increased signal on T2-weighted imaging and late gadolinium enhancement (LGE) in either a midwall or a subepicardial distribution. Previous reports have demonstrated a similar pattern of enhancement on delayed postcontrast CT.1–3 We present 2 cases of edema demonstrated on arterial phase CT coronary angiography (CTCA) in patients with clinical features that suggest acute myocarditis as confirmed by CMR. CT examinations were performed on a dual-source 64-detector CT scanner (SOMATOM Definition; Siemens Medical Solutions; Forchheim, Germany). Iomeron 350 (Iomoprol 71.4%; Bracco-Eisai; Tokyo, Japan) was injected at 6.5 mL/second into the cubital fossa through an 18-gauge cannula followed by a 50-mL saline flush. Scans were performed in the arterial phase, with triggering from the ascending aorta with a threshold of 100 Hounsfeld units. Both studies were acquired with dose-modulated, retrospective ECG gating. The tube voltage was set at 120 kV (peak) for the first case and 100 kV for the second case. CMR was performed with a 1.5-T GE Signa Twinspeed system (GE Healthcare; Milwaukee, WI) with an 8-element cardiac phased-array coil. LGE imaging was performed using a segmented inversion recovery fast-gradient echo sequence between 10 and 20 minutes after intravenous administration of 0.2 mmol/kg of gadolinium-diethylene triamine pentaacetic acid.