Multimodality Imaging of Pericardial Diseases
- 232 Downloads
Pericardial diseases have changed their epidemiology in the past few years. With the aging population and decreasing incidence of communicable diseases, the causes of pericardial diseases have significantly changed from infectious and malignant to postradiation and cardiac surgery causes. Despite that, pericardial diseases remain difficult to diagnose. The accurate and timely diagnosis of these diseases is essential to avoid the late sequela of pericardial constriction and pericardial cirrhosis. Echocardiography remains the first test of choice for the assessment of patients with suspected pericardial diseases. Most patients with acute pericarditis have a self-limiting course and do not need further imaging. However, in the era of multimodality imaging, other modalities, namely, computed tomography (CT) and magnetic resonance imaging (CMR), are often utilized in complex cases. These two modalities provide a wide-open view of the pericardium and adjacent structures. They have high resolution to assess pericardial calcification, a hallmark of many diseases especially tuberculous constrictive pericarditis. CMR is also unique in its ability to assess pericardial late gadolinium enhancement (LGE) and edema. These have been recently suggested to be very important in the progression from acute pericarditis to constrictive pericarditis. In addition, they provide prognostic value to assess which patients are at high risk of developing heart failure and resource utilization. Thus, in the current era, patients with suspected complex pericardial diseases will need a multimodality approach rather than a single modality approach.
KeywordsPericardial disease Magnetic resonance imaging Computed tomography Imaging
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmuller R, Adler Y, et al. Task Force on the D and Management of Pricardial Diseases of the European Society of C. 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. 2004;25:587–610.CrossRefPubMedGoogle Scholar
- 3.Kireyev D, Hung J. Pericardial disease. Card Imaging Clin Pract: Springer; 2016: 247.Google Scholar
- 6.Al-Mallah M, Kwong RY. Assessing pericardial disease by CMR. Cardiovasc Magn Reson Imaging. Humana Press;2008: 467.Google Scholar
- 13.Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36:2921–64.CrossRefPubMedGoogle Scholar
- 14.Rehman KA, Betancor J, Xu B, Kumar A, Rivas CG, Sato K, et al. Uremic pericarditis, pericardial effusion, and constrictive pericarditis in end-stage renal disease: insights and pathophysiology. Clin Cardiol. 2017; https://doi.org/10.1002/clc.22770.
- 16.Ristić AD, Imazio M, Adler Y, Anastasakis A, Badano LP, Brucato A, et al. Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2014;35:2279–84.CrossRefPubMedGoogle Scholar
- 17.Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013;26:965–1012 e15.CrossRefPubMedGoogle Scholar
- 21.Porta-Sánchez A, Sagristà-Sauleda J, Ferreira-González I, Torrents-Fernández A, Roca-Luque I, García-Dorado D. Constrictive pericarditis: etiologic spectrum, patterns of clinical presentation, prognostic factors, and long-term follow-up. Rev Esp Cardiol (Engl Ed). 2015;68:1092–100.CrossRefGoogle Scholar
- 23.Klein AL, Cohen GI, Pietrolungo JF, White RD, Bailey A, Pearce GL, et al. Differentiation of constrictive pericarditis from restrictive cardiomyopathy by Doppler transesophageal echocardiographic measurements of respiratory variations in pulmonary venous flow. J Am Coll Cardiol. 1993;22:1935–43.CrossRefPubMedGoogle Scholar
- 24.•• Alraies MC, Aljaroudi W, Yarmohammadi H, Yingchoncharoen T, Schuster A, Senapati A, et al. Usefulness of cardiac magnetic resonance-guided management in patients with recurrent pericarditis. Am J Cardiol. 2015;115:542–7. The aim of this study was to assess the utility of CMR in the management of RP compared with standard therapy. A total of 507 consecutive patients with RP after the first attack, all of whom were treated with colchicine and nonsteroidal anti-inflammatory drugs as first-line therapy, were retrospectively evaluated. CMR-guided therapy modulates the management of RP. This approach decreased pericarditis recurrence and exposure to steroids.CrossRefPubMedGoogle Scholar
- 41.Pinamonti B, Habjan S, De Luca A, Proclemer A, Morea G, Abate E, et al. Work-up and management of constrictive pericarditis: a critical review. G Ital Cardiol. 2016;17:197–207.Google Scholar
- 45.Feng D, Glockner J, Kim K, Martinez M, Syed IS, Araoz P, et al. Cardiac magnetic resonance imaging pericardial late gadolinium enhancement and elevated inflammatory markers can predict the reversibility of constrictive pericarditis after antiinflammatory medical therapy: a pilot study. Circulation. 2011;124:1830–7.CrossRefPubMedGoogle Scholar
- 46.Zurick AO, Bolen MA, Kwon DH, Tan CD, Popovic ZB, Rajeswaran J, et al. Pericardial delayed hyperenhancement with CMR imaging in patients with constrictive pericarditis undergoing surgical pericardiectomy: a case series with histopathological correlation. J Am Coll Cardiol Img. 2011;4:1180–91.CrossRefGoogle Scholar
- 47.•• Kumar A, Sato K, Yzeiraj E, Betancor J, Lin L, Tamarappoo BK, et al. Quantitative pericardial delayed hyperenhancement informs clinical course in recurrent pericarditis. JACC Cardiovasc Imaging. 2017; https://doi.org/10.1016/j.jcmg.2016.10.020. This is a retrospective cohort study of 159 patients with RP who underwent DHE imaging and had a follow-up period of more than 6 months. Pericardial inflammation was quantified on short-axis DHE sequences by contouring the pericardium, selecting normal septal myocardium as a reference region, and then quantifying the pericardial signal that was > 6 SD above the reference. Quantitative assessment of pericardial DHE was associated with clinical outcomes among patients with RP and provided incremental information regarding the clinical course of patients with RP.
- 48.•• Cremer PC, Tariq MU, Karwa A, Alraies MC, Benatti R, Schuster A, et al. Quantitative assessment of pericardial delayed hyperenhancement predicts clinical improvement in patients with constrictive pericarditis treated with anti-inflammatory therapy. Circ Cardiovasc Imaging. 2015;8:e003125. This study included 41 consecutive patients with constrictive pericarditis who had a cardiovascular magnetic resonance study with DHE prior to the initiation of anti-inflammatory medications. In patients with constrictive pericarditis treated with anti-inflammatory therapy, a quantitative assessment of pericardial DHE can provide incremental information to predict clinical improvement when added to clinical factors and Westergren sedimentation rates.CrossRefPubMedGoogle Scholar
- 52.Cangemi V, Volpino P, Gauldi G, Polettini E. Pericardial cysts of the mediastinum. J Cardiovasc Surg. 1999;40:909.Google Scholar