Emerging role of multimodality imaging in management of inflammatory pericardial diseases

Abstract

The non-specific and highly variable symptomatology of inflammatory pericardial diseases create clinical challenges in making accurate diagnosis, which often requires the integration of clinical findings, imaging and invasive hemodynamic assessment. Echocardiography is considered to be a first-line imaging test in pericardial diseases. Emerging imaging modalities, especially cardiac MRI allowed better understanding of pericardial anatomy, physiology and, for the first time, enable demonstration of the pericardial inflammation. On the other hand, cardiac computed tomography is excellent tool to define pericardial thickness, pericardial calcification and is useful for preoperative planning once pericardiectomy is indicated especially in the patients with prior cardiac surgery.

Keywords::

• cardiac MRI
• computed tomography
• echocardiography
• pericardial disease
• pericardial inflammation

Finanacial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Echocardiography remains the standard first-line imaging modality for identifying inflammatory pericardial disease, to detect the complication and guiding the intervention, for example, pericardiocentesis.

• • Cardiac computed tomography has outstanding advantages to delineate pericardial thickness and pericardial calcification with main limitation of ionizing radiation and iodinated contrast media exposure.

• • Cardiac MRI (CMR) allows better morphologic assessment and is complimentary to echocardiography for demonstrating constrictive physiology.

• • In patients with recurrent pericarditis, CMR-guided therapy was associated with the lower recurrence rate and pericardiocentesis when compared to the group without CMR-guided therapy.

• • Pericardial delayed hyperenhancement in constrictive pericarditis may indicate ongoing inflammation and the marker of reversibility in these patients. Patients with delayed hyperenhancement may benefit from a trial of anti-inflammatory agents before referring the patient directly to pericardiectomy.

Notes