5/20/2023 0 Comments Inmr line thicknessMoreover, transthoracic echocardiography is limited in its ability to aid in recognition of focal effusions, assessment of pericardial thickness, and characterization of tissue ( 10, 11). In particular, the diagnostic accuracy of echocardiography is limited in patients with a suboptimal acoustic window (eg, obese subjects, patients with severe chronic obstructive pulmonary disease or skeletal malformations) ( 9, 10). However, echocardiography may fail to allow adequate evaluation of the pericardium at times. The role of transthoracic echocardiography in helping diagnose pericardial disease has been well recognized for almost half a century, allowing both structural assessment and evaluation of the physiologic consequences to the heart ( 4– 8). The diagnosis of pericardial disease frequently remains clinically challenging, requiring integration of medical history and findings from physical examination, imaging, blood analyses, and, eventually, invasive hemodynamic measurements and/or pericardial biopsy ( 1– 3). Pericardial disease may be an incidental finding (eg, pericardial cyst) but may also necessitate urgent intervention in case of hemodynamic compromise (eg, acute cardiac tamponade, herniation of cardiac contents through a partial pericardial defect). Moreover, iatrogenic causes-for example, after cardiac surgery or radiation therapy-represent an important cause of pericardial-related morbidity and mortality. Besides isolated pericardial disease, the pericardium may be secondarily involved by a large group of organ and systemic diseases, such as infective, autoimmune, and neoplastic processes. It represents a heterogeneous group of congenital and acquired diseases, with a widely variable clinical manifestation that often necessitates a specific treatment. Pericardial disease is an important cause of morbidity and mortality in patients with cardiovascular disease. For this journal-based CME activity, author disclosures are listed at the end of this article. The ACCME requires that the RSNA, as an accredited provider of CME, obtain signed disclosure statements from the authors, editors, and reviewers for this activity. Physicans should claim only the credit commensurate with the extent of their participation in the activity. The RSNA designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit TM. The RSNA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Differentiate constrictive pericarditis from restrictive cardiomyopathy by assessing septal motion.Apply CT and MR techniques to the diagnosis of constrictive pericarditis, pericardial effusions, neoplasms, and congenital anomalies.Explain the contribution of pericardial anatomy and physiology to ventricular interdependence and diastolic filling.Describe the CT and MR appearances of normal pericardial anatomy, related sinuses and recesses, and potential diagnostic pitfalls.It focuses on the rapidly evolving insights regarding pericardial disease provided by modern imaging modalities, not infrequently necessitating reconsideration of evidence that has thus far been taken for granted.Īfter reading the article and taking the test, the reader will be able to: This review aims to elucidate the role of the pericardium and its interaction with the remainder of the heart in normal and pathologic conditions. MR imaging combines cardiac and pericardial anatomic assessment with tissue characterization and appraisal of the effects of pericardial abnormalities on cardiac performance. MR imaging is probably the best imaging modality for the acquisition of a comprehensive view of the pericardial abnormalities. Multidetector CT is by far the modality of choice for depiction of pericardial calcifications. Modern multidetector CT scanners merge acquisition speed and high spatial and contrast resolution, with volumetric scanning to provide excellent anatomic detail of the pericardium. ![]() ![]() Transthoracic echocardiography, which combines structural and physiologic assessment, is the first-line technique for examination of patients suspected of having or known to have pericardial disease however, cardiac computed tomography (CT) and magnetic resonance (MR) imaging are becoming increasingly popular for the study of this part of the heart. To a large extent, this can be attributed to the availability of several noninvasive cardiac imaging modalities. Fortunately, in recent years knowledge regarding this enigmatic part of the heart and the diagnosis of related diseases has substantially advanced. The pericardium represents an important focus of morbidity and mortality in patients with cardiovascular disease.
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