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Role of Cardiac MRI in Pericardial Diseases

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Abstract

Purpose of Review

To explore and highlight the important role that Cardiac MRI (CMR) plays as an imaging tool that not only facilitates the diagnosis of pericardial disease but is increasingly used to guide initiation of treatment and gauge adequacy of response to therapy in patients with acute and recurrent pericarditis is a specific focus of this review. An emphasis will be placed on the sequences that are currently utilized and novel sequences that could potentially be utilized for the diagnosis of pericarditis and pericardial disease.

Recent Findings

This article focuses on the CMR characteristics of the most encountered pericardial diseases and novel CMR techniques that may play an adjunctive role in the diagnosis, management, prognosis and the assessment of adequacy of response to therapy in patients with acute pericarditis.

Summary

CMR has emerged as a powerful tool in the diagnosis of pericardial disease. This is a review of the current and future roles that CMR-based sequences play in not only the diagnosis of pericardial disease, but also in evaluating the need for medical therapy and gauging adequacy of response to therapy in this cohort.

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Data Availability

No datasets were generated or analysed during the current study.

References

  1. Khandaker MH, Espinosa RE, Nishimura RA, et al. Pericardial disease: diagnosis and management. Mayo Clin Proc. 2010;85:572–93.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Adler Y, Charron P, Imazio M, 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.

    Article  PubMed  Google Scholar 

  3. Xu B, Harb SC, Klein AL. Utility of multimodality cardiac imaging in disorders of the pericardium. Echo Res Pract. 2018;5(2):R37–48.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Puntmann VO, Valbuena S, Hinojar R, et al. Society for cardiovascular magnetic resonance (SCMR) expert consensus for CMR imaging endpoints in clinical research: part I - analytical validation and clinical qualification. J Cardiovasc Magn Reson. 2018;20:67.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Morgenstern D, Kley J, Lisko J, Shivers L, Mikolich B, Mikolich JR. Chest pain in patients under age 40: are we getting it right? J Am Coll Cardiol. 2015;65:A1298–8.

    Article  Google Scholar 

  6. Bogaert J, Francone M. Cardiovascular magnetic resonance in pericardial diseases. J Cardiovasc Magn Reson. 2009;11:1–14.

    Article  Google Scholar 

  7. Chetrit M, Xu B, Kwon DH, et al. Imaging-guided therapies for pericardial diseases. JACC Cardiovasc Imaging. 2020;13:1422–37. This scientific paper represent relevant literature from the last three years on the role of MRI in myo-pericardial disease

    Article  PubMed  Google Scholar 

  8. Spodick DH. Macrophysiology, microphysiology, and anatomy of the pericardium: a synopsis. Am Heart J. 1992;124:1046–51.

    Article  CAS  PubMed  Google Scholar 

  9. LeWinter MM. Clinical practice. Acute pericarditis. N Engl J Med. 2014;371:2410–6.

    Article  PubMed  Google Scholar 

  10. Yared K, Baggish AL, Picard MH, Hoffmann U, Hung J. Multimodality imaging of pericardial diseases. JACC Cardiovasc Imaging. 2010;3:650–60.

    Article  PubMed  Google Scholar 

  11. Wang ZJ, Reddy GP, Gotway MB, Yeh BM, Hetts SW, Higgins CB. CT and MR imaging of pericardial disease. Radiographics. 2003;23:S167–80.

    Article  PubMed  Google Scholar 

  12. Bolen MA, Rajiah P, Kusunose K, et al. Cardiac MR imaging in constrictive pericarditis: multiparametric assessment in patients with surgically proven constriction. Int J Cardiovasc Imaging. 2015;31:859–66.

    Article  PubMed  Google Scholar 

  13. Aldweib N, Farah V, Biederman RWW. Clinical utility of cardiac magnetic resonance imaging in pericardial diseases. Curr Cardiol Rev. 2018;14:200–12.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Klein AL, Abbara S, Agler DA, 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.

    Article  PubMed  Google Scholar 

  15. Kojima S, Yamada N, Goto Y. Diagnosis of constrictive pericarditis by tagged cine magnetic resonance imaging. N Engl J Med. 1999;341:373–4.

    Article  CAS  PubMed  Google Scholar 

  16. Palumbo P, Ruscitti P, Cannizzaro E, et al. Unenhanced cardiac magnetic resonance may improve detection and prognostication of an occult heart involvement in asymptomatic patients with systemic sclerosis. Sci Rep. 2022;12:5125.

    Article  CAS  PubMed  PubMed Central  ADS  Google Scholar 

  17. Zurick AO, Bolen MA, Kwon DH, et al. Pericardial delayed hyperenhancement with CMR imaging in patients with constrictive pericarditis undergoing surgical pericardiectomy: a case series with histopathological correlation. JACC Cardiovasc Imaging. 2011;4:1180–91.

    Article  PubMed  Google Scholar 

  18. Brett NJ, Roper D, Slaughter RE, Hamilton-Craig C. CMR in the diagnosis of acute pericarditis. J Cardiovasc Magn Reson. 2011;13:O35.

    Article  PubMed Central  Google Scholar 

  19. Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation. 2006;114:1581–90.

    Article  PubMed  Google Scholar 

  20. Taylor AM, Dymarkowski S, Verbeken EK, Bogaert J. Detection of pericardial inflammation with late-enhancement cardiac magnetic resonance imaging: initial results. Eur Radiol. 2006;16:569–74.

    Article  PubMed  Google Scholar 

  21. Cremer PC, Tariq MU, Karwa 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 scientific paper represent relevant literature on the role of MRI in myo-pericardial disease

    Article  PubMed  Google Scholar 

  22. Yelgec NS, Dymarkowski S, Ganame J, Bogaert J. Value of MRI in patients with a clinical suspicion of acute myocarditis. Eur Radiol. 2007;17:2211–7.

    Article  PubMed  Google Scholar 

  23. Imazio M, Trinchero R. Myopericarditis: etiology, management, and prognosis. Int J Cardiol. 2008;127:17–26.

    Article  PubMed  Google Scholar 

  24. Spodick DH. Risk prediction in pericarditis: who to keep in hospital? Heart. 2008;94:398–9.

    Article  PubMed  Google Scholar 

  25. Kumar A, Sato K, Verma BR, et al. Quantitative assessment of pericardial delayed hyperenhancement helps identify patients with ongoing recurrences of pericarditis. Open Heart. 2018;5:e000944.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kumar A, Sato K, Yzeiraj E, et al. Quantitative pericardial delayed hyperenhancement informs clinical course in recurrent pericarditis. JACC Cardiovasc Imaging. 2017;10:1337–46.

    Article  PubMed  Google Scholar 

  27. Cremer P, Tariq M, Karwa A, Schuster A, Kwon D, Klein AL. Abstract 13844: quantitative analysis of pericardial inflammation with cardiac magnetic resonance imaging (CMR) predicts outcome in patients with constrictive pericarditis. Circulation. 2014;130:A13844–4.

    Google Scholar 

  28. Young PM, Glockner JF, Williamson EE, et al. MR imaging findings in 76 consecutive surgically proven cases of pericardial disease with CT and pathologic correlation. Int J Cardiovasc Imaging. 2012;28:1099–109.

    Article  PubMed  Google Scholar 

  29. Cremer PC, Kumar A, Kontzias A, et al. Complicated pericarditis: understanding risk factors and pathophysiology to inform imaging and treatment. J Am Coll Cardiol. 2016;68:2311–28. This scientific paper represent relevant literature on the role of MRI in myo-pericardial disease

    Article  PubMed  Google Scholar 

  30. Thavendiranathan P, Verhaert D, Walls MC, et al. Simultaneous right and left heart real-time, free-breathing CMR flow quantification identifies constrictive physiology. JACC Cardiovasc Imaging. 2012;5:15–24.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Alter P, Figiel JH, Rupp TP, Bachmann GF, Maisch B, Rominger MB. MR, CT, and PET imaging in pericardial disease. Heart Fail Rev. 2013;18:289–306.

    Article  CAS  PubMed  Google Scholar 

  32. Restrepo CS, Vargas D, Ocazionez D, Martínez-Jiménez S, Cuellar SLB, Gutierrez FR. Primary pericardial tumors. RadioGraphics. 2013;33:1613–30.

    Article  PubMed  Google Scholar 

  33. Choi JW, Moon WJ. Gadolinium deposition in the brain: current updates. Korean J Radiol. 2019;20:134–47.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA

    Chris Anthony, Emmanuel Akintoye, Tom Kai Ming Wang & Allan Klein

  2. The Alfred Hospital Melbourne and Monash Alfred Baker Centre for Cardiovascular Research, The Alfred Hospital, 55 Commercial Road, Prahran, Melbourne, Victoria, 3004, Australia

    Chris Anthony

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  1. Chris Anthony
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  4. Allan Klein
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Contributions

CA- Wrote Main manuscript text and prepared all figures. TW- Assisted with the manuscript text. EA- Assisted with figures. AK- Reviews manuscript text and figures.

Corresponding author

Correspondence to Allan Klein.

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The authors declare no competing interests.

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Anthony, C., Akintoye, E., Wang, T.K.M. et al. Role of Cardiac MRI in Pericardial Diseases. Curr Cardiovasc Imaging Rep 17, 43–51 (2024). https://doi.org/10.1007/s12410-024-09591-x

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  • DOI: https://doi.org/10.1007/s12410-024-09591-x

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