Radionuclide angiography and magnetic resonance imaging: complementary non-invasive methods in the diagnosis of constrictive pericarditis

Abstract

Constrictive pericarditis presents with a suggestive clinical picture, and its diagnosis is based on a haemodynamic pattern revealing impaired ventricular filling. In this study of 15 patients with pure isolated constrictive pericarditis, we attempted to evaluate the diagnostic value of two non-invasive methods not usually employed in this indication: radionuclide angiography (RNA) and magnetic resonance imaging (MRI). Whilst RNA permits analysis of the functional pattern of the global and segmental left ventricular filling impairment, MRI allows measurement of the thickness of the pericardium. RNA revealed increased early diastolic filling as evidenced by a shorter one-third filling time (TFl/3;P<0.0001 with respect to a normal population), a higher peak filling rate (PFR;P<0.01) and its early occurrence (P<0.001), increased one-third and mid diastolic filling fractions (P<0.01), and the ratio of the PFR over the peak ejection rate (P<0.01). During late diastole, the atrial filling fraction decreased (NS). The patients with constrictive pericarditis also showed a decrease in the physiological filling asynchrony, as assessed by segmental evaluations. Seven patients underwent MRI. The pericardium was thickened in all the patients, varying from 6 to 14 mm (normal: 2.5±0.7 mm), without any systolo-diastolic variation. Pericardial thickening appeared as a dark low-intensity signal band, demonstrating the fibrocalcific nature of the pericardial contents. Sagittal and coronal cross-sections were particularly well-suited to show the non-uniformity of the pericardial thickening. These results indicate that RNA and MRI are complementary non-invasive methods, and can provide the functional and anatomical information required for the diagnosis of constrictive pericarditis.