Constrictive pericarditis MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Atif Mohammad, M.D., Huda A. Karman, M.D.

MRI has been included in the multi-modality imaging guidelines for the diagnosis of constrictive pericarditis. It is of great value when echocardiography is non diagnostic of constrictive pericarditis and the suspicion remains high. MRI delineates two essential components of the evaluation: pericardial anatomy and functional imaging demonstrating ventricular interdependence. It also can be used to rule out restrictive cardiomyopathy. MRI is especially useful with the use of late gadolinium enhancement as it identifies pericardial inflammation when suspected in the context of a short duration of symptoms and elevated inflammatory markers.

Shown below is a video demonstrating MR findings of constrictive pericarditis where, in mid-diastole, the thickened pericardium begins to restrict right ventricular filling, causing a rapid increase in ventricular pressure^{[1] [2] [3]}. Early changes of septal flattening and bowing of the interventricular septum toward the left ventricle (normally concave in shape toward the left ventricle during diastolic filling) are seen. This pressure change results in diastolic septal dysfunction, the septal bounce described in echocardiography.

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