Cardiovascular magnetic resonance in pericardial diseases
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BioMed Central
Open Access
Review
Cardiovascular magnetic resonance in pericardial diseases Jan Bogaert*1 and Marco Francone2 Address: 1Department of Radiology, UZ Leuven, B-3000 Leuven, Belgium and 2Department of Radiology, University of La Sapienza, Rome, Italy Email: Jan Bogaert* - [email protected]; Marco Francone - [email protected] * Corresponding author
Published: 4 May 2009 Journal of Cardiovascular Magnetic Resonance 2009, 11:14
doi:10.1186/1532-429X-11-14
Received: 28 November 2008 Accepted: 4 May 2009
This article is available from: http://www.jcmr-online.com/content/11/1/14 © 2009 Bogaert and Francone; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract The pericardium and pericardial diseases in particular have received, in contrast to other topics in the field of cardiology, relatively limited interest. Today, despite improved knowledge of pathophysiology of pericardial diseases and the availability of a wide spectrum of diagnostic tools, the diagnostic challenge remains. Not only the clinical presentation may be atypical, mimicking other cardiac, pulmonary or pleural diseases; in developed countries a shift for instance in the epidemiology of constrictive pericarditis has been noted. Accurate decision making is crucial taking into account the significant morbidity and mortality caused by complicated pericardial diseases, and the potential benefit of therapeutic interventions. Imaging herein has an important role, and cardiovascular magnetic resonance (CMR) is definitely one of the most versatile modalities to study the pericardium. It fuses excellent anatomic detail and tissue characterization with accurate evaluation of cardiac function and assessment of the haemodynamic consequences of pericardial constraint on cardiac filling. This review focuses on the current state of knowledge how CMR can be used to study the most common pericardial diseases.
Pericardial anatomy and physiology Although the normal pericardium is a thin, avascular, relatively inelastic, flask-shaped sac enveloping the heart, this structure is an important determinant of cardiac filling [1-3]. In most cases, evaluation of pericardial diseases extends beyond morphologic assessment, and the diagnostic challenge is to determine the impact of abnormal pericardium on cardiac filling. Anatomically, the pericardium is composed of two layers, an inner serous membrane and an outer fibrocollagenous layer [3]. The inner serosal layer, termed the visceral pericardium, is closely attached to the epicardial surface of the heart and covers a subepicardial layer of conjunctive tissue containing fat and coronary vessels. The serosal layer reflects back on itself to become the inner lining of the outer fibrous layer. Together, these layers form the parietal pericar
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