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.

The first post-cardiac injury syndrome reported following transcatheter aortic valve implantation: a case report

“…CRP and/or sedimentation rate. Echocardiography, cardiac computed tomography, PET/CT, and cardiac MRI can characterize active inflammation, oedema, pericardial thickness, and pericardial effusion 4 , 5 …”

Usefulness of Cardiac Magnetic Resonance–Guided Management in Patients With Recurrent Pericarditis

“…In summary, a comprehensive pericardial CMR protocol should include morphologic evaluation of the cardiac chambers, pericardium, and mediastinum using fast spin-echo T1-weighted sequences with black-blood preparation; assessment of global and regional systolic function of the left and right ventricles, using cine steady-state free precession sequences; depiction of pericardial fluid and/or edema using T2-weighted spin-echo imaging, preferably by using shorttau inversion-recovery sequences; ventricular coupling using real-time free-breathing cine sequences; and tissue characterization using LGE inversion-recovery CMR. 13,19 All patients with initial CMR had !2 sequential studies to follow disease activity and response to treatment.…”

“…CMR has been used more in recent years to evaluate and follow the inflammation associated with disease activity. 13,14,19 LGE is a useful technique that reflects disease progression and has been used to guide practitioners in the titration of medical management. 14,25,26 LGE changes correlate with changes in inflammatory markers used to follow disease progression, mainly erythrocyte sedimentation rate and C-reactive protein.…”

When does pericarditis merit a workup for autoimmune or inflammatory disease?

“…Echocardiography, cardiac computed tomography, and cardiac MRI can characterize active inflammation, edema, pericardial thickness, and pericardial effusion. [6][7][8] Recurrent pericarditis is often resistant to standard therapy and requires corticosteroids in high doses, which paradoxically can increase the risk of recurrence. Therefore, further workup for underlying autoimmune disease, systemic inflammatory disease, or infection is necessary.…”