Multimodality Imaging of Pericardial Disease

The emergence of multimodality imaging of pericardial diseases has improved diagnosis and management. In acute pericarditis, echocardiography is the first-line test, but cardiac magnetic resonance (CMR) may be beneficial in patients who fail to respond to therapy. An increased T2 short-tau inversion recovery time (STIR) suggests pericardial edema, and increased late gadolinium enhancement (LGE) suggests organizing pericarditis. Computed tomography (CT) can be helpful in procedural planning, either to guide percutaneous drainage of an effusion or to assess calcification and the location of vascular structures before pericardiectomy. On echocardiography, a respiratory septal shift in combination with either a preserved medial e' velocity or prominent expiratory diastolic hepatic vein flow reversal performs well in diagnosing constrictive pericarditis. These patients also have decreased regional longitudinal strain in the anterolateral and right ventricular free walls, presumably related to pericardial to myocardial tethering. Finally, prominent LGE may identify patients with constrictive pericarditis who improve with anti-inflammatory therapy.