Abstract
To assess the utility of cardiac magnetic resonance (MR) imaging in the diagnosis of constrictive pericarditis (CP). This study was approved by the institutional review board, with a waiver of informed consent. A total of 42 consecutive patients (mean age, 55 ± 16 years; 3 women, 39 men) with CP treated with pericardiectomy who had undergone cardiac MR before surgery were evaluated retrospectively. An additional 21 patients were evaluated as a control group; of these, 10 consecutive patients received cardiac MR for reasons other than suspected pericardial disease, and 11 consecutive patients had a history of pericarditis but no clinical suspicion of pericardial constriction. MR imaging parameters were analyzed independently and with a decision tree algorithm for usefulness in the prediction of CP. Catheterization data were also reviewed when available. A model combining pericardial thickness and relative interventricular septal (IVS) excursion provided the best overall performance in prediction of CP (C statistic, 0.98, 100 % sensitivity, 90 % specificity). Several individual parameters also showed strong predictive value in the assessment of constriction, including relative IVS excursion (sensitivity, 93 %; specificity, 95 %), pericardial thickness (sensitivity, 83 %; specificity, 100 %), qualitative assessment of pathologic coupling (sensitivity, 88 %; specificity, 100 %), diastolic IVS bounce (sensitivity, 90 %; specificity, 85 %), left ventricle area change (sensitivity, 86 %; specificity, 100 %), and eccentricity index (sensitivity, 86 %; specificity, 90 %; all P < 0.001). Strong agreement was observed between catheterization and surgical findings of constriction (97 %). Cardiac MR provides robust quantitative and qualitative analysis for the diagnosis of CP.
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The authors thank Megan M. Griffiths, scientific writer for the Imaging Institute, Cleveland Clinic, for editorial assistance.
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10554_2015_616_MOESM1_ESM.mp4
Movie 1 (supplemental): Breath-hold cine steady-state free procession images in 4-chamber orientation show an abnormal septal bounce as well as abrupt cessation of diastolic filling (MP4 78 kb)
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Bolen, M.A., Rajiah, P., Kusunose, K. et al. Cardiac MR imaging in constrictive pericarditis: multiparametric assessment in patients with surgically proven constriction. Int J Cardiovasc Imaging 31, 859–866 (2015). https://doi.org/10.1007/s10554-015-0616-z
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DOI: https://doi.org/10.1007/s10554-015-0616-z