[Current indications for cardiac MR imaging]

Use of magnetic resonance imaging in assessment of constrictive pericarditis: a Moroccan center experience

Background

The diagnosis of constrictive pericarditis continues to be a clinical challenge. Magnetic resonance imaging provides excellent visualization of the pericardium. The aim of our study is to clarify the contribution of this non invasive exploration in the diagnosis of constrictive pericarditis in our center.

Methods

we conducted a prospective study over a period of two years, since 2008, covering a series of patients (n = 11), mean age 44 ± 15 years, in whom constrictive pericarditis was suspected clinically and on transthoracic echocardiography. We studied its characteristics on magnetic resonance imaging.

Results

Magnetic resonance imaging confirmed the diagnosis showing pericardial thickening in all cases, measuring 8.2 +/- 2.6 mm on average, circumferential in 64%, and localized in 36%. The imaging data, particularly pericardial thickening and its topography, were confirmed by surgical exploration, and results were concordant in all cases.

Conclusion

Magnetic resonance imaging is a powerful tool to establish constrictive pericarditis diagnosis.

[Chronic constrictive pericarditis: MR imaging features]

Chronic constrictive pericarditis is defined by an increase in the rigidity of the pericardium resulting in impairment of the ventricular filling conditions. Cardiac MR is both a morphological and functional study always complemented by multi-detector CT. Morphological analysis is based on axial, longitudinal long axis and short axis views on Turbo (fast) SE Dark Blood and CINE sequences. Functional analysis is based on real-time acquisitions in the short axis at the base of the ventricles by comparing spontaneous breathing and deep breathing. The excursion of the interventricular septum is a reliable sign of constriction. The study is supplemented by phase contrast acquisitions. In the setting of persistent inflammation or free pericardial fluid, delayed enhancement 3D and 2D sequences including Phase Sensitive Inversion Recovery (PSIR) are useful.