Multi-modality Imaging Assessment of Pericardial Masses

This review will discuss the application of various imaging modalities including their advantages and disadvantages in the evaluation of the most common pericardial masses with a focus on pericardial cysts, tumors, and hematomas.

Accurate identification of pericardial masses and assessment of potential hemodynamic compromise is imperative for management. Cardiac imaging plays a central role in tissue characterization as well as evaluation of extension into neighboring structures. Currently, echocardiography is the preferred modality for the initial evaluation due to its low cost and widespread availability. However, due to potential limitations with echocardiography, computed tomography (CT), and cardiac magnetic resonance (CMR) imaging have become robust complementary imaging tests. CT provides superior spatial resolution and is the ideal test for evaluation of calcified masses while CMR provides excellent tissue characterization through various CMR sequences. Finally, positron emission tomography (PET) imaging can provide additional unique information in the assessment of potentially malignant tumors. An integrated, multi-modality imaging approach is helpful to evaluate the pericardium and diagnose pericardial masses. Advancements in imaging technology have provided improved diagnostic accuracy, with CT and CMR currently serving as complementary imaging techniques to traditional echocardiography imaging. Because each imaging modality has its unique sets of advantages and disadvantages, the choice of modality must be individualized to each patient. Through careful consideration, an integrated imaging approach is crucial in noninvasively providing information on cardiac structure, morphology, function, and associated complications that are important to the diagnosis and management of a variety of pericardial masses.