Diagnosis of pericarditis with current imaging techniques is not always straightforward. As pericarditis is an inflammatory process, IR-CE-MRI (similar to late enhancement myocardial MRI) may be of value for detecting pericardial inflammation.

An MRI study that included late enhancement acquisitions after contrast-administration (0.2 mmol/kg bodyweight Gd-DTPA) was performed in 31 patients with clinical suspicion of pericardial disease (PD group), 22 patients with a recent history (<3weeks) of acute MI (AMI group), and 12 patients with no clinical evidence of pericardial disease (CON group). Images were analyzed for the presence of pericardial effusion, pericardial thickening and pericardial enhancement.

Enhancement of the pericardial layers was found in 11/31 (moderate: 4, strong: 7) patients in the PD group, which was not related to the concomitant presence of pericardial fluid. Enhancement was helpful for demonstrating acute inflammation of the pericardial layers, differentiating inflammatory from fibrosing forms of chronic pericarditis, and defining the different components of pericardial thickening (e.g. pericardial layers vs pericardial effusion). Although in the AMI group minimal pericardial effusion was found in 12 patients, in only 4 was pericardial enhancement detected (moderate: 2, slight: 2). The two patients with moderate pericardial enhancement had clinical evidence of post-infarction pericarditis. In all 12 patients in the CON group, no pericardial thickening or enhancement was demonstrated.

The present study results suggest a more versatile use for IR-CE-MRI, enabling visualisation of pericardial inflammation in patients with clinical suspicion of pericardial disease and detection of post-infarction pericarditis in patients with recent acute MI.