Myocardial hypoenhancement in a case of acute coronary syndrome with normal coronary arteries: demonstration by 64-slice multidetector computed tomography

A 48-year-old man presented with severe chest pain that had started 2 h before and ST elevation on the electrocardiogram. Cardiac computed tomography (CT) was performed using a 64-slice multidetector scanner (MDCT) to assess coronary artery stenosis at 3 h after the onset. Coronary CT angiography showed no significant stenosis at the coronary arteries, but CT myocardial images at systole demonstrated predominantly subendocardial hypoenhancement in the anterior wall. Cardiac CT that combined coronary angiography and myocardial imaging demonstrated myocardial hypoenhancement in a case of acute coronary syndrome with normal coronary arteries, which may be related to microvascular dysfunction caused by vasospastic angina or microvascular angina.