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Pericardial disease

a) SCMR official document standardized acquisition guidelines – relevant extract

1. LV structure and function module
2. T1 or T2-weighted fast spin echo images
   a. 2–3 representative long axis images and 3–4 representative short axis images to measure pericardial thickness (normal ≤ 3 mm)
   b. If pericardial cyst is suspected, refer to masses protocol
3. Optional – If regions of thickened pericardium noted –T1-weighted gradient echo myocardial tagged cine sequences to demonstrate presence or absence of epicardial/pericardial slippage (2–3 long axis images and 1–2 short axis images)
4. Optional, but encouraged if available – real-time imaging in the short axis during dynamic breathing maneuvers for evaluation of ventricular interdependence
Late Gadolinium Enhancement module

b) SCMR official document reporting recommendations – relevant extract

Morphology (descriptive)
1. Pericardial Thickness: describe as local or circumferential and list thickness measurements
2. Pericardial effusion (None, trace, small, moderate, large)
Ventricular parameters
1. LV volumes (EDV, ESV, SV, EF) with and without indexing for BSA.
Ventricular wall motion
1. Systolic wall motion
2. +/- abnormal septal motion during normal respiration and breath holding.
3. Presence or absence of atrial inversion
Late Gadolinium Enhancement
1. RV – site
2. LV – site
3. Pericardium

c) Standardized web based images

Pericardial constriction case
Case notes: Case from the Heart Hospital, London.  Note the pericardial thickening on the HASTE images (series_4), better seen on the TSE images, (series_22 to _29). There is a pleural effusion, and breath-hold cines show a septal bounce, but the real-time imaging in the short axis during dynamic breathing maneuvers shows marked inspiratory septal flattening - ventricular interdependence (series_18). Note also the right hemidiaphragmn is essentially stationary (series_19)

d) Case of the Week example(s)

Number 10-25: Constrictive Pericarditis Post Cardiac Transplant: Diagnostic Role of Cardiovascular MRI
History: A 56-year old male underwent heart transplantation (HTX) 8 years ago.

Number 10-24: Acute Pericarditis
History: A 58-year old man, free from any previous medical history, presented to the emergency department with retrosternal oppressive chest pain, varying with inspiration and posture, of rapid installation and evolution after prolonged direct exposure to cold airflow from an air-conditioner.

Number 06-03: Pericardial constriction
History: A 59 year old presented with paroxysmal atrial fibrillation, breathlessness, ankle oedema and disturbed liver function tests.

Number 07-16: Late Mediastinal malignancy treatment complications
History: Increasing Breathlessness. Past medical history included a thymoma removal with subsequent mediastinal radiotherapy. Previous successful PCI to the LAD for radiation induced coronary artery disease.

e) Expert opinion – ‘How we do’

"How I Do" CMR in Pericardial Disease (Brian J. Schietinger and Christopher M. Kramer)

f) Relevant Online Talks

No recorded talks on the pericardium present.

h) Relevant papers (starting point):

Westwoods MA, Moon JC. Cardiovascular magnetic resonance for pericardial disease. IJRI, 2007;133-6

Cardiovascular magnetic resonance in pericardial diseases
Jan Bogaert, Marco Francone
Journal of Cardiovascular Magnetic Resonance 2009, 11:14 (4 May 2009)
[Abstract] [Full Text] [PDF]