Longitudinal cardiac MRI assessment in constrictive pericarditis: a case series

Abstract

Diagnosing and monitoring of constrictive pericarditis (CP) is challenging. Cardiac magnetic resonance imaging (CMR) offers superior visualization of pericardial thickness, inflammation, and fibrosis, helping assess disease progression and treatment response. This case series explores the role of CMR in monitoring CP, tracking disease progression, assessing treatment response, and guiding clinical decisions. This case series included six patients with CP who underwent serial CMR imaging. Clinical data and CMR findings—such as pericardial thickness, late gadolinium enhancement (LGE), T2 STIR signal, and ventricular interdependence—were recorded before and after treatment. CMR effectively tracked changes in pericardial structure and function over time. Persistent pericardial thickening and LGE were common, even after symptomatic improvement. Inflammatory activity is often reduced with treatment, but signs of constriction could remain. CMR helped distinguish reversible inflammation from irreversible fibrosis and guided decisions such as continued medical therapy or pericardiectomy. Serial CMR is a valuable tool in managing CP, offering insights into disease activity, treatment effectiveness, and functional impact. Persistent imaging abnormalities despite clinical improvement highlight the need for long-term monitoring and individualized treatment strategies.