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Restelli D, Carerj ML, Bella GD, Zito C, Poleggi C, D’Angelo T, Donato R, Ascenti G, Blandino A, Micari A, Mazziotti S, Minutoli F, Baldari S, Carerj S. Constrictive Pericarditis: An Update on Noninvasive Multimodal Diagnosis. J Cardiovasc Echogr 2023; 33:161-170. [PMID: 38486689 PMCID: PMC10936705 DOI: 10.4103/jcecho.jcecho_61_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 03/17/2024] Open
Abstract
Constrictive pericarditis (CP) is a rare condition that can affect the pericardium after every pericardial disease process and has been described even after SARS-CoV-2 infection or vaccine. In CP, the affected pericardium, usually the inner layer, is noncompliant, constraining the heart to a fixed maximum volume and impairing the diastolic function. This leads to several clinical features, that, however, can be pleomorphic. In its difficult diagnostic workup, noninvasive multimodal imaging plays a central role, providing important morphological and functional data, like the enhanced ventricular interdependence and the dissociation between intrathoracic and intracardiac pressures. An early and proper diagnosis is crucial to set an appropriate therapy, changing the prognosis of patients affected by CP. In this review, we cover in detail the main elements of each imaging technique, after a reminder of pathophysiology useful for understanding the diagnostic findings.
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Affiliation(s)
- Davide Restelli
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Maria Ludovica Carerj
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Cristina Poleggi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Tommaso D’Angelo
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Rocco Donato
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Antonio Micari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Fabio Minutoli
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
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Wang TKM, Ayoub C, Chetrit M, Kwon DH, Jellis CL, Cremer PC, Bolen MA, Flamm SD, Klein AL. Cardiac Magnetic Resonance Imaging Techniques and Applications for Pericardial Diseases. Circ Cardiovasc Imaging 2022; 15:e014283. [DOI: 10.1161/circimaging.122.014283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac magnetic resonance imaging plays a central role among multimodality imaging modalities in the assessment, diagnosis, and surveillance of pericardial diseases. Clinicians and imagers should have a foundational understanding of the utilities, advantages, and limitations of cardiac magnetic resonance imaging and how they integrate with other diagnostic tools involved in the evaluation and management of pericardial diseases. This review aims to outline the contemporary magnetic resonance imaging sequences used to evaluate the pericardium, followed by exploring the main clinical applications of magnetic resonance imaging for identifying pericardial inflammation, constriction, and effusion.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., M.C., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.‚ A.L.K.)
- Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.)
- Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A.‚ D.H.K., C.L.J., P.C.C., A.L.K.)
| | - Chadi Ayoub
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., M.C., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.‚ A.L.K.)
- Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.)
- Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A.‚ D.H.K., C.L.J., P.C.C., A.L.K.)
| | - Michael Chetrit
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., M.C., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.‚ A.L.K.)
- Department of Cardiovascular Medicine, McGill University Health Centre, Montreal, Quebec, Canada (M.C.)
| | - Deborah H. Kwon
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., M.C., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.‚ A.L.K.)
- Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.)
- Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A.‚ D.H.K., C.L.J., P.C.C., A.L.K.)
| | - Christine L. Jellis
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., M.C., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.‚ A.L.K.)
- Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.)
- Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A.‚ D.H.K., C.L.J., P.C.C., A.L.K.)
| | - Paul C. Cremer
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., M.C., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.‚ A.L.K.)
- Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.)
- Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A.‚ D.H.K., C.L.J., P.C.C., A.L.K.)
| | - Michael A. Bolen
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., M.C., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.‚ A.L.K.)
- Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.)
| | - Scott D. Flamm
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., M.C., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.‚ A.L.K.)
- Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.)
| | - Allan L. Klein
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A., M.C., D.H.K., C.L.J., P.C.C., M.A.B., S.D.F.‚ A.L.K.)
- Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH. (T.K.M.W., C.A.‚ D.H.K., C.L.J., P.C.C., A.L.K.)
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Glynn P, Hale S, Hussain T, Freed BH. Cardiovascular Imaging for Systemic Sclerosis Monitoring and Management. Front Cardiovasc Med 2022; 9:846213. [PMID: 35433887 PMCID: PMC9008238 DOI: 10.3389/fcvm.2022.846213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Systemic sclerosis (SSc) is a complex connective tissue disease with multiple clinical and subclinical cardiac manifestations. SSc can affect most structural components of the heart, including the pericardium, myocardium, valves, and conduction system through a damaging cycle of inflammation, ischemia, and fibrosis. While cardiac involvement is the second leading SSc-related cause of death, it is frequently clinically silent in early disease and often missed with routine screening. To facilitate identification of cardiac disease in this susceptible population, we present here a review of cardiac imaging modalities and potential uses in the SSc patient population. We describe well-characterized techniques including electrocardiography and 2D echocardiography with Doppler, but also discuss more advanced imaging approaches, such as speckle-tracking echocardiography, cardiovascular magnetic resonance imaging (CMR), and stress imaging, among others. We also suggest an algorithm for the appropriate application of these modalities in the workup and management of patients with SSc. Finally, we discuss future opportunities for cardiac imaging in SSc research to achieve early detection and to optimize treatment.
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Affiliation(s)
- Peter Glynn
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah Hale
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Tasmeen Hussain
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Benjamin H. Freed
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- *Correspondence: Benjamin H. Freed,
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Pericardiectomy for constrictive pericarditis at a single Japanese center: 20 years of experience. Gen Thorac Cardiovasc Surg 2022; 70:430-438. [PMID: 35119592 DOI: 10.1007/s11748-021-01718-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/06/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Constrictive pericarditis (CP) is a rare disease, and the diagnosis and surgical treatment of CP remain challenging. The aim of this study was to evaluate our Japanese single-center experience with isolated pericardiectomy for CP to elucidate the factors associated with improved outcomes. METHODS Over a 20-year period, 44 consecutive patients underwent isolated pericardiectomy at our institution. The cause of CP was: idiopathic (59%), postsurgical (32%), tuberculosis (7%), and postradiation (2%) of the patients. All patients were diagnosed with CP using multiple modalities, including echocardiography, cardiac catheterization, computed tomography, or magnetic resonance imaging (MRI). Median sternotomy was performed in 42 (95%) patients. Twenty-eight (68%) patients underwent radical pericardiectomy. RESULTS The postoperative diagnosis in all patients was CP. Among the multiple modalities, cardiac MRI had the greatest diagnostic sensitivity (97.2%). There were no operative or hospital deaths; late mortality occurred in seven (15.9%) patients in the series. Multivariable analysis showed that preoperative low LVEF was a risk factor for long-term mortality. Seven patients were readmitted for heart failure postoperatively. Multivariable analysis showed incomplete pericardiectomy and use of a preoperative inotrope were risk factors for readmission for heart failure. CONCLUSIONS The diagnosis using multimodality imaging for CP was effective in our institution and tagged cine MRI had the greatest sensitivity in diagnosing CP. Preoperative condition, including preoperative low LVEF or inotrope use, was correlated with long-term outcome after pericardiectomy. Pericardiectomy should be performed early and as radically as possible to prevent recurrent heart failure.
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Mano TB, Santos H, Rosa SA, Thomas B, Baquero L. Cardiac magnetic resonance in the assessment of pericardial abnormalities: a case series. Eur Heart J Case Rep 2021; 5:ytab444. [PMID: 34993400 PMCID: PMC8728722 DOI: 10.1093/ehjcr/ytab444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/27/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Cardiac magnetic resonance (CMR) has a unique role in evaluating pericardial disease, permitting non-invasive tissue analysis, and haemodynamic assessment.
Case summary
In Case 1 of recurrent pericarditis, CMR confirmed reactivation of inflammation with late gadolinium enhancement and native T1/T2 mapping techniques, prompting therapeutic changes. In constrictive pericarditis, CMR is the only modality capable of differentiating a subacute potentially reversible form (Case 2), from a chronic, burnt out irreversible phase characterized by constrictive physiology (Case 3).
Discussion
Cardiac magnetic resonance is an effective tool to tailor individual therapy, particularly in cases of recurrent and constrictive pericarditis. Late gadolinium enhancement provides diagnostic and prognostic information, and multiparametric mapping has emerged as a promising tool with incremental diagnostic value.
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Affiliation(s)
- T Branco Mano
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Rua de Santa Marta, nr. 50, 1169-024 Lisbon, Portugal
| | - H Santos
- Cardiology Service, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - S Aguiar Rosa
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Rua de Santa Marta, nr. 50, 1169-024 Lisbon, Portugal
- Heart Center, Hospital da Cruz Vermelha Portuguesa, Portugal
| | - B Thomas
- Heart Center, Hospital da Cruz Vermelha Portuguesa, Portugal
| | - L Baquero
- Heart Center, Hospital da Cruz Vermelha Portuguesa, Portugal
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Hasnie AA, Miller NJ, Davies J, Von Mering G. Constrictive Pericarditis Presenting as Isolated Ascites. Radiol Case Rep 2021; 17:259-264. [PMID: 34849181 PMCID: PMC8609104 DOI: 10.1016/j.radcr.2021.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
Constrictive pericarditis is a rare cause of right-sided heart failure secondary to a stiff, non-compliant pericardium. Clinical presentation can vary considerably and requires a high suspicion for diagnosis. A 31-year-old male presented to the emergency department with complaints of abdominal distension. An abdominal ultrasound revealed large volume ascites; thus, it was initially suspected he had underlying cirrhosis. However, an echocardiogram revealed a diagnosis of constrictive pericarditis. It's important for clinicians to consider constrictive pericarditis in a patient presenting with unexplained right-sided heart failure.
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Affiliation(s)
- Ammar A Hasnie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Neal J Miller
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - James Davies
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Gregory Von Mering
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
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Biederman RWW. Does chance really favor (only) the prepared mind? The role of MRI tissue-tagging in solving a most vexing problem for the interventionalist. Int J Cardiovasc Imaging 2021; 37:3069-3072. [PMID: 34392442 DOI: 10.1007/s10554-021-02364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Robert W W Biederman
- Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital, Temple University School of Medicine, Allegheny Health Network, Carnegie Mellon University, 320 E. North Avenue, Pittsburgh, PA, 15212, USA.
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Abstract
Purpose of Review The purpose of this review is to summarize the application of cardiac magnetic resonance (CMR) in the diagnostic and prognostic evaluation of patients with heart failure (HF). Recent Findings CMR is an important non-invasive imaging modality in the assessment of ventricular volumes and function and in the analysis of myocardial tissue characteristics. The information derived from CMR provides a comprehensive evaluation of HF. Its unique ability of tissue characterization not only helps to reveal the underlying etiologies of HF but also offers incremental prognostic information. Summary CMR is a useful non-invasive tool for the diagnosis and assessment of prognosis in patients suffering from heart failure.
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Affiliation(s)
- Chuanfen Liu
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Victor A. Ferrari
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
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Groner LK, Green DB, Weisman SV, Legasto AC, Toy D, Gruden JF, Escalon JG. Thoracic Manifestations of Rheumatoid Arthritis. Radiographics 2021; 41:32-55. [PMID: 33411607 DOI: 10.1148/rg.2021200091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Rheumatoid arthritis (RA) is one of the most common chronic systemic inflammatory diseases and the most common chronic inflammatory arthritis. Classically a progressive symmetric polyarthritis, RA is characterized by inflammation, erosions, bone loss, and joint destruction. Up to half of patients with RA exhibit extra-articular manifestations (EAMs), which may precede articular disease and are more common in patients with seropositive RA (patients with detectable serum levels of rheumatoid factor and/or anticitrullinated peptide antibodies). Cardiovascular and pulmonary EAMs are the largest contributors to morbidity and mortality in RA and may be especially devastating. Imaging has a significant role in diagnosing these EAMs and assessing response to treatment. Although treatment with disease-modifying antirheumatic drugs has redefined the natural history of RA and helped many patients achieve low disease activity, patients are at risk for treatment-related complications, as well as infections. The clinical features of drug-induced lung disease and infection can overlap considerably with those of EAMs, presenting a diagnostic challenge. Radiologists, by recognizing the imaging characteristics and evolution of these various processes, are essential in diagnosing and distinguishing among EAMs, treatment-related complications, and unrelated processes and formulating an appropriate differential diagnosis. Moreover, recognizing these disease processes at imaging and contextualizing imaging findings with clinical information and laboratory and pathologic findings can facilitate definitive diagnosis and proper treatment. The authors review the articular and extra-articular thoracic imaging manifestations of RA, including cardiovascular, respiratory, and pleural diseases, as well as treatment-related complications and common infections. ©RSNA, 2021.
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Affiliation(s)
- Lauren K Groner
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Daniel B Green
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Stacey V Weisman
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Alan C Legasto
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Dennis Toy
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - James F Gruden
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Joanna G Escalon
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
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Cardiovascular magnetic resonance (CMR) in restrictive cardiomyopathies. Radiol Med 2020; 125:1072-1086. [PMID: 32970272 PMCID: PMC7593297 DOI: 10.1007/s11547-020-01287-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
The restrictive cardiomyopathies constitute a heterogeneous group of myocardial diseases with a different pathogenesis and overlapping clinical presentations. Diagnosing them frequently poses a challenge. Echocardiography, electrocardiograms and laboratory tests may show non-specific changes. In this context, cardiac magnetic resonance (CMR) may play a crucial role in defining the diagnosis and guiding treatments, by offering a robust myocardial characterization based on the inherent magnetic properties of abnormal tissues, thus limiting the use of endomyocardial biopsy. In this review article, we explore the role of CMR in the assessment of a wide range of myocardial diseases causing restrictive patterns, from iron overload to cardiac amyloidosis, endomyocardial fibrosis or radiation-induced heart disease. Here, we emphasize the incremental value of novel relaxometric techniques such as T1 and T2 mapping, which may recognize different storage diseases based on the intrinsic magnetic properties of the accumulating metabolites, with or without the use of gadolinium-based contrast agents. We illustrate the importance of these CMR techniques and their great support when contrast media administration is contraindicated. Finally, we describe the useful role of cardiac computed tomography for diagnosis and management of restrictive cardiomyopathies when CMR is contraindicated.
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11
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Panda S, Irodi A, Daniel R, Chacko BR, Vimala LR, Gnanamuthu BR. Utility of cine MRI in evaluation of cardiovascular invasion by mediastinal masses. Indian J Radiol Imaging 2020; 30:280-285. [PMID: 33273761 PMCID: PMC7694725 DOI: 10.4103/ijri.ijri_69_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/10/2020] [Accepted: 06/21/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Accurate imaging assessment of cardiovascular invasion by mediastinal masses is essential for determining surgical feasibility. This can sometimes be difficult on CT owing to limited space available in the mediastinum, resulting in mediastinal masses abutting and indenting adjacent cardiovascular structures. Cine MRI may aid in such situations by demonstrating differential mobility. AIMS AND OBJECTIVES To evaluate the role of cine MRI in assessing cardiovascular invasion by mediastinal masses, by evaluating sliding motion and the presence of chemical shift artifact between the mediastinal mass and apposing structures. MATERIAL AND METHODS Retrospective study of 44 patients with mediastinal masses, with equivocal involvement of 162 cardiovascular structures on CT scan, in whom cine MRI was done. Involvement on CT was considered equivocal when there was a loss of intervening fat plane and broad surface (>3 cm) or angle (>90°) of contact between the mediastinal mass and cardiovascular structure. The presence of either sliding movement or type 2 chemical shift artifact or both between mass and the cardiovascular structure was considered as no adherence or invasion. The absence of both the parameters was considered as the presence of invasion or adhesion. Imaging findings were correlated with intraoperative findings. RESULTS After excluding 25 cardiovascular structures in 7 patients, 137 cardiovascular structures whose involvement was suspected on CT were evaluated in 37 patients with mediastinal masses. In all, 31 cardiovascular structures showed invasion on MRI out of which 28 structures were invaded or adhered intraoperatively and 106 cardiovascular structures showed no invasion on MRI out of which 97 structures were intraoperatively not invaded/adhered. The sensitivity, specificity and accuracy of our study are 75.7%, 97% and 91.2%, respectively. CONCLUSION Cine MRI can be used as an effective tool in patients with equivocal cardiovascular invasion by mediastinal masses on CT scans.
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Affiliation(s)
- Sourav Panda
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Riya Daniel
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Binita R Chacko
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Leena R Vimala
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Birla R Gnanamuthu
- Department of Cardiothoracic Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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12
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Alajaji W, Xu B, Sripariwuth A, Menon V, Kumar A, Schleicher M, Isma’eel H, Cremer PC, Bolen MA, Klein AL. Noninvasive Multimodality Imaging for the Diagnosis of Constrictive Pericarditis. Circ Cardiovasc Imaging 2018; 11:e007878. [DOI: 10.1161/circimaging.118.007878] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wissam Alajaji
- Department of Cardiovascular Medicine, Summa Health Heart and Vascular Institute, Akron, OH (W.A.)
| | - Bo Xu
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | | | - Vivek Menon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Arnav Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Mary Schleicher
- Cleveland Clinic Alumni Library (M.S.), Cleveland Clinic, OH
| | | | - Paul C. Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Michael A. Bolen
- Cardiovascular Section, Imaging Institute (A.S., M.A.B.), Cleveland Clinic, OH
| | - Allan L. Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
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Aldweib N, Farah V, Biederman RWW. Clinical Utility of Cardiac Magnetic Resonance Imaging in Pericardial Diseases. Curr Cardiol Rev 2018; 14:200-212. [PMID: 29921208 PMCID: PMC6131401 DOI: 10.2174/1573403x14666180619104515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/28/2018] [Accepted: 06/12/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Pericardial diseases are relatively common in clinical practice and encountered in various clinical settings with consequent significant morbidity and mortality. However, the diagnosis as well as management can be complex and challenging, as the clinical presentation is usually non-specific. Therefore, there is an increasing role for Cardiac Magnetic Resonance Imaging (CMR) as an imaging tool to facilitate the diagnosis of pericardial diseases. Conclusion: Herein we describe conventional and unique CMR approaches to provide an increased non-invasive understanding of the pericardium in health and disease including a novel method to diagnose constrictive pericarditis via radio-frequency tissue tagging by defining unique visceral-parietal adherence patterns easily learned by the cardiologist and radiologist.
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Affiliation(s)
- Nael Aldweib
- Division of Cardiology, Center for Cardiac MRI. Allegheny General Hospital, East North Ave, Pittsburgh, PA, United States
| | - Victor Farah
- Division of Cardiology, Center for Cardiac MRI. Allegheny General Hospital, East North Ave, Pittsburgh, PA, United States
| | - Robert W W Biederman
- Division of Cardiology, Center for Cardiac MRI. Allegheny General Hospital, East North Ave, Pittsburgh, PA, United States
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14
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15
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Ardhanari S, Yarlagadda B, Parikh V, Dellsperger KC, Chockalingam A, Balla S, Kumar S. Systematic review of non-invasive cardiovascular imaging in the diagnosis of constrictive pericarditis. Indian Heart J 2016; 69:57-67. [PMID: 28228308 PMCID: PMC5318986 DOI: 10.1016/j.ihj.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/26/2016] [Accepted: 06/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Diagnosis of constrictive pericarditis (CP) can be challenging. It can be nearly impossible to distinguish CP from other causes of right heart failure. Although various imaging modalities help in the diagnosis, no test is definitive. Several reviews have addressed the role of various imaging techniques in the diagnosis of CP but a systematic review has not yet been published. Objective Our intention was to study the ability of various non-invasive imaging modalities to diagnose CP in patients with surgically confirmed disease and to apply our findings to develop a clinically useful diagnostic algorithm. Methods A PubMed (NLM) search was performed with MeSH term “constrictive pericarditis”. Original articles that investigated the ability of various cardiovascular imaging modalities to noninvasively diagnose surgically confirmed CP were included in our review. Investigations that included any cases without surgical confirmation were excluded. Results The PubMed search yielded 3001 results with MeSH term “constrictive pericarditis” (January 8, 2016). We identified (40) studies on CP that matched our inclusion criteria. We summarized our results sorted by individual non-invasive CV imaging modalities – echocardiography, cardiac computed tomography (CT), and magnetic resonance imaging (MRI). Under each imaging modality, we grouped our discussion based on different parameters useful in CP diagnosis. Conclusions In conclusion, contemporary diagnosis of CP is based on clinical features and echocardiography. Cardiac MRI is recommended in patients where echocardiography is not diagnostic. Both cardiac MRI and CT can guide surgical planning but we prefer MRI as it provides both structural and functional information.
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Affiliation(s)
- Sivakumar Ardhanari
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Bharath Yarlagadda
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Vishal Parikh
- Department of Cardiology, University of South Florida, Tampa, FL, United States
| | - Kevin C Dellsperger
- Department of Medicine, Augusta University Health, Augusta, GA, United States
| | - Anand Chockalingam
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Sudarshan Balla
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Senthil Kumar
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States.
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16
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Glower DD. Sticking points in magnetic resonance diagnosis of constrictive pericarditis. J Thorac Cardiovasc Surg 2016; 151:1356-7. [PMID: 27085615 DOI: 10.1016/j.jtcvs.2015.12.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Donald D Glower
- Department of Surgery, Duke University Medical Center, Durham, NC.
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