Multimodality Imaging of Pericardial Diseases

Abstract

Pericardial disease is an important cause of morbidity and mortality in patients with cardiovascular disease. Inflammatory diseases of the pericardium constitute a spectrum ranging from acute pericarditis to chronic constrictive pericarditis. Other important entities that involve the pericardium include benign and malignant pericardial masses, pericardial cysts, and diverticula, as well as congenital absence of the pericardium. Recent advances in multimodality noninvasive cardiac imaging have solidified its role in the management of patients with suspected pericardial disease. The physiologic and structural information obtained from transthoracic echocardiography and the anatomic detail provided by cardiac computed tomography and magnetic resonance have led to growing interest in the complementary use of these techniques. Optimal management of the patient with suspected pericardial disease requires familiarity with the key imaging modalities and the ability to choose the appropriate imaging tests for each patient. This report reviews the imaging modalities most useful in the assessment of patients with pericardial disease, with an emphasis on the complementary value of multimodality cardiac imaging.

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

“…rezonans magnetyczny serca -CMR) mogą ujawnić pierwsze oznaki zaciskającego zapalenia osierdzia, w fazie odwracalnej choroby, dzięki czemu wdrożenie farmakoterapii i preparatów przeciwzapalnych może przyczynić się do rzadszego wykonywania zabiegów chirurgicznych [2,[39][40][41].…”

Pericardial Masses, Cysts and Diverticula: A Comprehensive Review Using Multimodality Imaging

“…3 It is important to be able to differentiate these cysts from other structures which may be present in the same location, including the pericardial sinuses. Intravenous contrast, color-flow and pulsed-wave Doppler can be used to demonstrate a lack of vascular flow within the structure.…”

“…Intravenous contrast, color-flow and pulsed-wave Doppler can be used to demonstrate a lack of vascular flow within the structure. 3 As with pericardial masses, cross-sectional imaging modalities, such as cCT and cMRI, have proven superior to echocardiography for the identification and characterization of pericardial cysts and diverticula as well as their relation to adjacent structures. 52 …”

“…Pericardial fluid is often only seen in systole as a thin, hypoechoic line around the myocardium and the pericardium is not directly visualized unless either the parietal or visceral pericardial layer is >5 mm thick. 3 On cardiac computed tomography (cCT) the pericardium is visualized as a bright, linear structure around the heart in contrast to surrounding fat with an average thickness of 1.3-2.5 mm. 3,4 By Cardiac Magnetic Resonance Imaging (cMRI) the average pericardial thickness is 1.2 mm in diastole and 1.7 mm in systole with variable visualization depending on the image plane.…”

“…3 On cardiac computed tomography (cCT) the pericardium is visualized as a bright, linear structure around the heart in contrast to surrounding fat with an average thickness of 1.3-2.5 mm. 3,4 By Cardiac Magnetic Resonance Imaging (cMRI) the average pericardial thickness is 1.2 mm in diastole and 1.7 mm in systole with variable visualization depending on the image plane. 5 Pericardial fluid has low-signal intensity on T 1 -weighted sequences; however, with fat suppression the background signal becomes suppressed and pericardial fluid develops a high signal intensity.…”