How to Use Multimodality Imaging for Pericarditis

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Pericarditis diagnosis and management require accurate assessment of inflammatory activity and chronicity.
• Transthoracic echocardiography is limited in pericardial tissue characterization.
• Multimodality imaging offers complementary strengths for comprehensive pericarditis evaluation.

Purpose of the Study:

• To synthesize guideline-aligned applications of multimodality imaging in pericarditis.
• To propose a simplified framework for imaging-guided therapy in pericarditis.
• To highlight common pitfalls and system-level constraints in pericarditis imaging.

Main Methods:

• Cardiac magnetic resonance (CMR) for pericardial edema and late gadolinium enhancement (LGE).
• Cardiac computed tomography (CT) for anatomic detail (thickness, calcification, effusions).
• ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for metabolically active inflammation.

Main Results:

• CMR sensitively assesses edema and LGE for active inflammation vs. chronic fibrosis.
• CT provides detailed anatomy for planning pericardiectomy and managing complex effusions.
• FDG-PET/CT detects active inflammation in ambiguous or refractory cases, guiding advanced therapy.

Conclusions:

• Multimodality imaging is essential for accurate pericarditis phenotyping and guiding therapy.
• A framework using key imaging biomarkers (edema, LGE, thickening, effusion, constriction, fibrosis) enables tailored treatment strategies.
• Imaging guides treatment escalation/tapering in recurrent disease and patient selection for pericardiectomy.