Cardiac MRI in evaluation and management of pediatric pericarditis

Highlights

• Cardiac MRI can be useful in the evaluation of pediatric pericarditis.

• Cardiac MRI frequently demonstrated pericardial late gadolinium enhancement indicating active pericardial inflammation in selected patients, who had a normal echocardiogram.

• Cardiac MRI is comparable to echocardiogram in demonstrating constrictive physiology.

• There is a higher degree of late gadolinium enhancement in patients with systemic disease and recurrent pericarditis.

Abstract

Background

Evaluation of pediatric pericarditis depends on the physical examination, electrocardiography and echocardiography. However, a multimodality imaging approach which includes cardiac magnetic resonance imaging (MRI) has been adopted in the adult population. The use of such an approach in the pediatric population has not been studied well.

Objective

The present study was intended to describe a single institution's experience with the use of cardiac MRI in the evaluation of pericarditis in the pediatric population.

Study Design

A retrospective review of patients who had a cardiac MRI before the age of 21 years, between 2005 and 2014, to evaluate for pericardial pathology including pericarditis, constrictive pericarditis, recurrent pericarditis and pericardial effusion was performed. Patients were excluded if the cardiac MRI was done for evaluation of pathologies other than those related to the pericardium. Patients with predominant myocarditis were also excluded. The cardiac MRI and the echocardiograms were reviewed by a single blinded investigator.

Results

Twenty-one patients satisfied the inclusion criteria. The study population were predominantly male (81%) older adolescents (mean age: 17 ± 3 years). The major indications for cardiac MRI included evaluation of myocardial involvement in acute pericarditis, modulation of therapy in recurrent pericarditis and confirmation of constriction. Cardiac MRI was comparable to echocardiogram in detecting constrictive physiology and was useful in determining the presence of active pericardial inflammation. Systemic inflammatory diseases demonstrated higher values on quantification of late gadolinium enhancement.

Conclusion

We have reported on a relatively large series of pediatric patients with pericarditis evaluated by cardiac MRI. Cardiac MRI may be a useful adjunct to conventional imaging in selected pediatric patients with pericarditis.

Introduction

Pericarditis is characterized by inflammation of the pericardium. It can be acute, incessant, recurrent or chronic and can be complicated by pericardial effusion leading to cardiac tamponade or constrictive pericarditis [[1], [2], [3]]. Similar to adults, pericarditis in childhood can be secondary to infectious or non-infectious causes (rheumatologic, metabolic, neoplastic or post-surgical) or can be idiopathic and can lead to complications [[3], [4], [5], [6]]. Evaluation of pediatric pericarditis depends on the physical examination, electrocardiography and echocardiography. However, a multi-modality imaging approach, which includes cardiac magnetic resonance imaging (MRI) has been adopted in the adult population [1,3,7]. Reports on the use of cardiac MRI for the evaluation of pediatric pericarditis have been limited to case reports. The present study was intended to describe our single institution's experience with the use of cardiac MRI in the evaluation of pericarditis in the pediatric population.