ROLE OF CT AND MRI IN DIAGNOSIS OF PERICARDIAL DISEASES

Abstract

P ericardial disease is an important cause of morbidity and mortality in patients with cardiovascular disease. Although the pericardium is usually sufficiently thick to be identified on CCT and CMR, visualization at the most common site of pericardial defects, the lateral, posterior, and inferior left ventricular wall, can be poor because of a paucity of fat. Trans-thoracic echocardiography (TTE) should be the first modality to determine the hemodynamic significance of a pericardial effusion. Both CCT and CMR imaging are useful adjuncts to TTE in the characterization of a pericardial effusion and tamponade. They both play an important role in situations in which the hemodynamics are atypical and the presence and severity of tamponade are less certain. Both CCT and CMR provide more detailed quantification and localization of the effusion than TTE, and they are especially useful to guide pericardiocentesis, since loculated or regional effusions or regions of calcified pericardium can be identified. When hemopericardium complicates aortic dissection, CCT and CMR can readily identify the 2 diagnoses, thereby preventing inappropriate and potentially catastrophic pericardiocentesis. Loculated effusions, especially those in anterior locations, can be difficult to detect at echocardiography but are readily demonstrated at CT or MR imaging, both of which provide a wider field of view. CT attenuation measurements also enable the initial characterization of pericardial fluid.