Timing of LGE imaging in patients undergoing CMR for suspected pericarditis: the later the better?

Abstract

We present a case series of four patients who underwent cardiac magnetic resonance imaging (CMR) including late gadolinium enhancement (LGE) for suspected pericarditis. All patients fulfilled the clinical criteria for pericarditis according to current ESC guidelines (one patient with acute pericarditis, two patients with incessant pericarditis, and one patient with chronic pericarditis). Additionally, all patients demonstrated LGE and thickening of the pericardium on CMR confirming the clinical diagnosis of pericarditis, whereas no concomitant myocardial involvement was observed. Pericardial contrast enhancement in rapid routine LGE image was compared with LGE images acquired following a longer waiting time after Gadolinium injection (gadoteridol). After a longer than rapid clinical routine waiting time, we observed more prominent pericardial signal enhancement in the setting of pericarditis (Panel). Although the diagnosis of pericarditis can be established by clinical criteria, CMR imaging is increasingly used to evaluate concomitant myocardial involvement and/or to exclude other disease entities. Besides well-known morphologic findings like pericardial effusion, thickening, or adhesion, pericardial LGE imaging has been demonstrated to be the most sensitive surrogate of pericarditis. While there is a lot of data regarding the optimal timing of LGE for the detection of myocardial damage, the optimal timing of LGE for the detection of pericarditis is unknown. In the recent advent of rapid high-throughput CMR protocols, high diagnostic accuracy needs to be maintained not only for myocardial diseases but also for the assessment of the pericardium.