MR, CT, and PET imaging in pericardial disease

Abstract

Although echocardiography remains the standard diagnostic tool for identifying pericardial diseases, procedures with better delineation of morphology and heart function are often required. The pericardium consists of an inner visceral (epicardium) and outer parietal layer (pericardium), which constitute for the pericardial cavity. Pericardial effusion can occur as transudate, exudate, pyopneumopericardium, or hemopericardium. Potential causes are inflammatory processes, that is, pericarditis due to autoimmune or infective reasons, neoplasms, irradiation, or systemic disorders, chronic renal failure, endocrine, or metabolic diseases. Pericardial fat can mimic pericardial effusion. Using various image-acquisition sequences, MRI allows identifying and separating fluid and solid structures. Fast spin-echo T1-weighted sequences with black-blood preparation are favourably used for morphological evaluation. Fast spin-echo T2-weighted sequences, particularly with fat saturation, and short-tau inversion-recovery sequences are useful to visualize oedema and inflammation. For further tissue characterization, delayed inversion-recovery imaging is used. Therefore, image acquisition is performed at 5-20 min subsequent to contrast agent administration, the so-called technique of late gadolinium enhancement. Ventricular volumes and myocardial mass can be assessed accurately by steady-state free-precession sequences, which is required to measure cardiac function and ventricular wall stress. Constrictive pericarditis usually results from chronic inflammatory processes leading to increased stiffness, which impedes the slippage of both pericardial layers and thereby the normal cardiac filling. CT imaging can favourably assess pericardial calcification. Thus, MR and CT imaging allow a comprehensive delineation of the pericardium. Superior to echocardiography, both methods provide a larger field of view and depiction of the complete chest including abnormalities of the surrounding mediastinum and lungs. PET provides unique information on the in vivo metabolism of 18-fluorodeoxyglucose that can be superimposed on CT findings and is useful for identifying inflammatory processes or masses, for example neoplasms. These imaging techniques provide advanced information of anatomy and cardiac function to optimize the pericardial access, for example by the AttachLifter system, for diagnosis and treatment.

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

“…Budowę tkanek serca i osierdzia można ocenić w obrazie T1-zależnym ciemnego sygnału krwi oraz w obrazie T2-zależnym ciemnego sygnału krwi, w obrazie echa spinowego w sekwencji STIR (sekwencja zależna od czasu inwersji dla tkanki tłuszczowej), za pomocą SSFP i w obrazie T1-zależnym po podaniu kontrastu i/lub poprzez późne wzmocnienie kontrastu (LCE) po dożylnym podaniu paramagnetycznych chelatów gadolinu [3,4,114]. Sekwencja LCE opiera się na inwersji odbudowie sygnału pre-pulse, co wzmacnia kontrast i umożliwia uwidocznienie zmian zapalnych w osierdziu [114,115].…”

Low-field magnetic resonance anatomic features of the neonatalfoal thorax: an ex vivo study

“…These sequences provided a good depiction of anatomical structures. Some reports describe thoracic diseases using the same sequences (1,25). However, in live animals the technical changes including use of closed-bore 1.5 T high-field configuration, a cardio-respiratory gating, and different sequences produce high-quality diagnostic images without artefacts (4,13).…”

“…In human medicine, computed tomography (CT) and magnetic resonance imaging (MRI) are diagnostic techniques used in assessment of the thorax because of their high spatial and temporal resolutions, large fields of view, and multiplanar imaging reconstruction capabilities (1)(2)(3). Manipulation of the relative signal intensities of normal and abnormal tissue through appropriate use of MRI pulse sequences, the absence of ionizing radiation, and the ability to acquire images in nonaxial imaging planes are the relative advantages of MRI over CT (4,5).…”

“…MRI provides views of the structures without superimposition, a capacity to discriminate the different tissues (7,8), and high diagnostic value (9). MRI also provides a larger field of view and depicts the complete chest including abnormalities of the surrounding mediastinum and inflammatory processes (1). Therefore, MRI has been used to assess chest wall, mediastinum, and diaphragm diseases (10,11), as well as the neonatal heart (12)(13)(14).…”

Myocardial homing of mesenchymal stem cells following intrapericardial application and amplification by inflammation — an experimental pilot study

“…Intracoronary, intramyocardial, and retrograde coronary venous stem cell transplantation has been applied; however, the optimal approach remains unknown, and use of the pericardial sac has not been sufficiently explored in this regard. The pericardium is known as an appropriate target of anti-inflammatory drug delivery, e.g., for treatment of pericarditis (Adler et al 2015;Alter et al 2013;Glück et al 2016;Maisch and Pankuweit 2012). In addition, it is known that drugs applied into the pericardial space can penetrate the myocardium (Marcano et al 2013).…”