Abstract
To assess the utility of cardiac magnetic resonance (MR) imaging in the diagnosis of constrictive pericarditis (CP). This study was approved by the institutional review board, with a waiver of informed consent. A total of 42 consecutive patients (mean age, 55 ± 16 years; 3 women, 39 men) with CP treated with pericardiectomy who had undergone cardiac MR before surgery were evaluated retrospectively. An additional 21 patients were evaluated as a control group; of these, 10 consecutive patients received cardiac MR for reasons other than suspected pericardial disease, and 11 consecutive patients had a history of pericarditis but no clinical suspicion of pericardial constriction. MR imaging parameters were analyzed independently and with a decision tree algorithm for usefulness in the prediction of CP. Catheterization data were also reviewed when available. A model combining pericardial thickness and relative interventricular septal (IVS) excursion provided the best overall performance in prediction of CP (C statistic, 0.98, 100 % sensitivity, 90 % specificity). Several individual parameters also showed strong predictive value in the assessment of constriction, including relative IVS excursion (sensitivity, 93 %; specificity, 95 %), pericardial thickness (sensitivity, 83 %; specificity, 100 %), qualitative assessment of pathologic coupling (sensitivity, 88 %; specificity, 100 %), diastolic IVS bounce (sensitivity, 90 %; specificity, 85 %), left ventricle area change (sensitivity, 86 %; specificity, 100 %), and eccentricity index (sensitivity, 86 %; specificity, 90 %; all P < 0.001). Strong agreement was observed between catheterization and surgical findings of constriction (97 %). Cardiac MR provides robust quantitative and qualitative analysis for the diagnosis of CP.
Similar content being viewed by others
References
Maisch B, Seferovic PM, Ristic AD et al (2004) Guidelines on the diagnosis and management of pericardial diseases executive summary—The task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J 25(7):587–610
Little WC, Freeman GL (2006) Pericardial disease [erratum (2007) in Circulation 115(15): e406]. Circulation 113(12):1622–1632
Nishimura RA (2001) Constrictive pericarditis in the modern era: a diagnostic dilemma. Heart 86(6):619–623
Ling LH, Oh JK, Schaff HV et al (1999) Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation 100(13):1380–1386
Rajiah P (2011) Cardiac MRI: part 2, pericardial diseases. AJR Am J Roentgenol 197(4):W621–W634
Francone M, Dymarkowski S, Kalantzi M, Rademakers FE, Bogaert J (2006) Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy. Eur Radiol 16(4):944–951
Francone M, Dymarkowski S, Kalantzi M, Bogaert J (2005) Real-time cine MRI of ventricular septal motion: a novel approach to assess ventricular coupling. J Magn Reson Imaging 21(3):305–309
Giorgi B, Mollet NR, Dymarkowski S, Rademakers FE, Bogaert J (2003) Clinically suspected constrictive pericarditis: MR imaging assessment of ventricular septal motion and configuration in patients and healthy subject. Radiology 228(2):417–424
Thavendiranathan P, Verhaert D, Walls MC et al (2012) Simultaneous right and left heart real-time, free-breathing CMR flow quantification identifies constrictive physiology. JACC Cardiovasc Imaging 5(1):15–24
Bauner K, Horng A, Schmitz CH, Reiser M, Huber A (2010) New observations from MR velocity-encoded flow measurements concerning diastolic function in constrictive pericarditis. Eur Radiol 20(8):1831–1840
Lachhab A, Doghmi N, Zouhairi A et al (2011) Use of magnetic resonance imaging in assessment of constrictive pericarditis: a Moroccan center experience. Int Arch Med 4:36
Anavekar NS, Wong BF, Foley TA et al (2013) Index of biventricular interdependence calculated using cardiac MRI: a proof of concept study in patients with and without constrictive pericarditis. Int J Cardiovasc Imaging 29(2):363–369
Zurick AO, Bolen MA, Kwon DH et al (2011) Pericardial delayed hyperenhancement with CMR imaging in patients with constrictive pericarditis undergoing surgical pericardiectomy: a case series with histopathological correlation. JACC Cardiovasc Imaging 4(11):1180–1191
Ryan T, Petrovic O, Dillon JC, Feigenbaum H, Conley MJ, Armstrong WF (1985) An echocardiographic index for separation of right ventricular volume and pressure overload. J Am Coll Cardiol 5(4):918–927
Talreja DR, Edwards WD, Danielson GK et al (2003) Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation 108(15):1852–1857
Acknowledgments
The authors thank Megan M. Griffiths, scientific writer for the Imaging Institute, Cleveland Clinic, for editorial assistance.
Conflict of Interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
10554_2015_616_MOESM1_ESM.mp4
Movie 1 (supplemental): Breath-hold cine steady-state free procession images in 4-chamber orientation show an abnormal septal bounce as well as abrupt cessation of diastolic filling (MP4 78 kb)
Rights and permissions
About this article
Cite this article
Bolen, M.A., Rajiah, P., Kusunose, K. et al. Cardiac MR imaging in constrictive pericarditis: multiparametric assessment in patients with surgically proven constriction. Int J Cardiovasc Imaging 31, 859–866 (2015). https://doi.org/10.1007/s10554-015-0616-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-015-0616-z