Multimodality Imaging Approach in the Diagnosis of Constrictive Pericarditis

Constrictive pericarditis (CP) results from persistent or insufficiently controlled pericardial inflammation arising from diverse etiologies. It remains a challenging clinical condition, typically presenting with non-specific symptoms that demand a high degree of clinical suspicion and meticulous imaging assessment. As CP progressively impairs both left- and right-sided cardiac function, it can lead to overt heart failure and a marked decline in quality of life, making early recognition crucial. Multimodality imaging plays an essential role in the diagnostic and prognostic evaluation of CP, enabling distinction from restrictive cardiomyopathy (RCM), detection of active pericardial inflammation, and guidance of therapeutic decision-making. Echocardiography provides key hemodynamic insights, including ventricular interdependence and respiratory variation in flow patterns. Cardiac Computed Tomography (CT) offers high-resolution delineation of pericardial thickening and calcification, while Cardiac magnetic resonance (CMR) allows comprehensive characterization of pericardial anatomy, myocardial-pericardial coupling, and inflammatory burden through late gadolinium enhancement (LGE) and parametric mapping. Additionally, positron emission tomography (PET) imaging can identify metabolically active inflammation, aiding in determining the suitability of medical therapy versus pericardiectomy. By integrating these complementary modalities, clinicians can achieve greater diagnostic precision, refine risk stratification, and tailor management strategies, ultimately improving outcomes for patients with constrictive pericarditis.