CMR in Pericardial Diseases - an Update

Vidalakis, Eleftherios; Kolentinis, Michalis; Gawor, Monika; Vasquez, M; Nagel, Eike

doi:10.1007/s12410-020-9535-z

Cited by 20 publications

(12 citation statements)

References 57 publications

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“…Myocardial LGE was visually defined by two observers based on the presence and predominant pattern as ischemic or non-ischemic 44 . Pericardial involvement was considered present when enhancement involved both pericardial layers, irrespective of the size of pericardial effusion 46 . Cine images were employed for derivation of GLS analyses using Medis Suite MR version 2.1 (Medis Medical Imaging Systems) 47 .…”

Section: Methodsmentioning

confidence: 99%

Long-term cardiac pathology in individuals with mild initial COVID-19 illness

Püntmann

Martin

Shchendrygina

et al. 2022

Nat Med

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Cardiac symptoms are increasingly recognized as late complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in previously well individuals with mild initial illness, but the underlying pathophysiology leading to long-term cardiac symptoms remains unclear. In this study, we conducted serial cardiac assessments in a selected population of individuals with Coronavirus Disease 2019 (COVID-19) with no previous cardiac disease or notable comorbidities by measuring blood biomarkers of heart injury or dysfunction and by performing magnetic resonance imaging. Baseline measurements from 346 individuals with COVID-19 (52% females) were obtained at a median of 109 days (interquartile range (IQR), 77–177 days) after infection, when 73% of participants reported cardiac symptoms, such as exertional dyspnea (62%), palpitations (28%), atypical chest pain (27%) and syncope (3%). Symptomatic individuals had higher heart rates and higher imaging values or contrast agent accumulation, denoting inflammatory cardiac involvement, compared to asymptomatic individuals. Structural heart disease or high levels of biomarkers of cardiac injury or dysfunction were rare in symptomatic individuals. At follow-up (329 days (IQR, 274–383 days) after infection), 57% of participants had persistent cardiac symptoms. Diffuse myocardial edema was more pronounced in participants who remained symptomatic at follow-up as compared to those who improved. Female gender and diffuse myocardial involvement on baseline imaging independently predicted the presence of cardiac symptoms at follow-up. Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness.

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Section: Methodsmentioning

confidence: 99%

Long-term cardiac pathology in individuals with mild initial COVID-19 illness

Püntmann

Martin

Shchendrygina

et al. 2022

Nat Med

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“…From myocardial studies it is indicated that diseases with myocardial thinning with partial volume effects, such as dilative cardiomyopathy, are important factors leading to changes in parametric mapping values and causing alterations related to structural thickness even without changes in the tissue structure 9 23. Although parametric mapping has increasingly been used for the diagnosis of myocardial diseases, pericardial mapping is still hampered due to the thin nature of the healthy pericardium surrounded by high-intensity epicardial fat and medium-intensity myocardium 24–26. To further assess the clinical value of T1/T2 mapping beyond a convoluted way of measuring structural thickness, those parameters should be evaluated against each other and regressed for.…”

Section: Discussionmentioning

confidence: 99%

Parametric mapping CMR for the measurement of inflammatory reactions of the pericardium

et al. 2022

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ObjectivesAlthough cardiovascular magnetic resonance (CMR) is increasingly used to diagnose pericardial inflammation, imaging can still be challenging using conventional CMR techniques. Parametric mapping (T1/T2 mapping) techniques have emerged as novel methods to quantify focal and global changes of the myocardium without contrast agent. The aim of the present study was to implement parametric mapping to facilitate diagnostic decision-making in pericardial inflammation.MethodsTwenty patients with pericardial inflammation underwent CMR (1.5T system) including T1-weighted/T2-weighted imaging, T1/T2 mapping and late gadolinium enhancement. T1/T2 mapping was performed in end-diastole covering three short-axis slices. Diagnosis of pericardial inflammation was made according to recent guidelines. T1/T2 measurements were pursued by manually drawing regions of interest (ROIs) in the thickened, diseased pericardium carefully avoiding contamination by other cardiac structures. Parametric values were correlated to further markers of pericardial inflammation, such as pericardial thickening and inflammatory parameters.ResultsOn average, the pericardium displayed a thickness of 4.8±1.0 mm. Mean T1 value was 1363.0±227.1 ms and T2 value was 123.3±52.6 ms, which were above patient’s myocardial values (myocardial T1: 998.7±81.0 ms, p<0.001, median 1014.46 ms; T2: 68.0±28.9 m,p<0.001) and the values of a group of four patients with chronic pericarditis (T1: 953.0±16.7 ms; T2: 63.2±10.1 ms). T1 and T2 showed a correlation to the extent of the thickened pericardium (R=0.64, p=0.002 for T1, R=0.72, p=0.005 for T2). There was no correlation of pericardial T1/T2 to blood markers of inflammation, myocardial injury (C reactive protein, troponin, creatine kinase) or further CMR parameters.ConclusionsIn patients with pericardial inflammation, parametric mapping showed elevated T1 and T2 values. Parametric mapping may help to facilitate diagnosis of pericardial inflammation if conventional parameters such as pericardial hyperintensity in T1-weighted or T2-weighted imaging or contrast agent uptake are heterogeneous.

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“… 4 , 5 Native T1 has also the potential of detailed tissue characterization, allowing the distinction between pericardial enhancement and pericardial fat (both positive in LGE sequences). 3 …”

Section: Discussionmentioning

confidence: 99%

Cardiac magnetic resonance in the assessment of pericardial abnormalities: a case series

Mano

Santos

Rosa

et al. 2021

European Heart Journal - Case Reports

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Background Cardiac Magnetic Resonance (CMR) has a unique role in evaluating pericardial disease, permitting non-invasive tissue analysis and hemodynamic assessment. Case Summary In Case 1 of recurrent pericarditis, CMR confirmed reactivation of inflammation with late gadolinium enhancement (LGE) and native T1/T2 mapping techniques, prompting therapeutic changes. In constrictive pericarditis, CMR is the only modality capable of differentiating a subacute potentially reversible form (Case 2), from a chronic, burnt out irreversible phase characterized by constrictive physiology (Case 3). Discussion CMR is an effective tool to tailor individual therapy, particularly in cases of recurrent and constrictive pericarditis. LGE provides diagnostic and prognostic information, and multiparametric mapping has emerged as a promising tool with incremental diagnostic value.

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CMR in Pericardial Diseases - an Update

Cited by 20 publications

References 57 publications

Long-term cardiac pathology in individuals with mild initial COVID-19 illness

Long-term cardiac pathology in individuals with mild initial COVID-19 illness

Parametric mapping CMR for the measurement of inflammatory reactions of the pericardium

Cardiac magnetic resonance in the assessment of pericardial abnormalities: a case series

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