Role of Multimodality Imaging in the Evaluation of Pericardial Diseases

Abstract

Pericardial diseases are a heterogeneous category of disorders, including pericardial effusion, cardiac tamponade, acute and recurrent pericarditis, constrictive pericarditis, and pericardial masses, which require a timely and precise assessment because of varying clinical manifestations and potentially dire outcomes. Imaging is required in diagnosis, risk stratification, therapeutic planning, and follow-up. Nevertheless, there is no imaging modality that can be used to exhaustively describe the intricate anatomic, hemodynamic, and inflammatory characteristics of pericardial disease. Multimodality imaging has thus become a vital approach to a holistic evaluation. The first method is the use of echocardiography because it is the most available, can be performed at the bedside, and can provide real-time hemodynamic information particularly in pericardial effusion and tamponade. Computed tomography is specifically useful in pericardial calcification, thickness, and masses or complicated anatomy and has a great spatial resolution. Inflammation, edema, fibrosis and constrictive physiology can only be determined by cardiac magnetic resonance, which is also the best in tissue characterization. Positron emission tomography and hybrid imaging also provide extra diagnostic capabilities and assess metabolic activity of inflammatory and malignant diseases. A stepwise and integrated imaging method enhances the accuracy of the diagnosis, distinguishes between similar clinical syndromes, and allows personalized treatment. The development of new technologies like hybrid imaging and artificial intelligence is likely to improve the assessment of pericardial diseases, and increase accuracy in clinical judgment.