title: Cardiac MR imaging in constrictive pericarditis: multiparametric assessment in patients with surgically proven constriction.
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.
authors: Imaging Institute, Cardiovascular Section, Cleveland Clinic, 9500 Euclid Avenue, J1-4, Cleveland, OH, 44195, USA, bolenm@ccf.org.
authors: Michael A
authors: MA
authors: Bolen
authors: Prabhakar
authors: P
authors: Rajiah
authors: Kenya
authors: K
authors: Kusunose
authors: Patrick
authors: P
authors: Collier
authors: Allan
authors: A
authors: Klein
authors: Zoran B
authors: ZB
authors: Popović
authors: Scott D
authors: SD
authors: Flamm
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D006328:Cardiac Catheterization; D002302:Cardiac Output; D002496:Central Venous Pressure; D003663:Decision Trees; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy; D010494:Pericarditis, Constrictive / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D010496:Pericardium / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D017725:Ventricular Pressure