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О журнале Архив Содержание


Материалы
Международного межуниверситетского семинара по диагностической и терапевтической радиологии

Минск, 20-21 октября 2003 года

MR and CT in the Diagnosis of Pericardial Disease and Myocardial Inflammation.
Prof. R. Rienmiiller
Interdisciplinary Cardiac Imaging Center, Medical University of Graz, Austria.
(Радиология в медицинской диагностике [современные технологии] 2003: 72-73)

The normal pericardium is seen on advanced computed tomography as a thin line of soft tissue density between the mediastinal and subepicardial fat from the pars diaphragmatica till the superior junction line. Because of its anatomy and of its functional tasks it appears in front of the right heart a little bit thicker than along the left heart. Similar appearance is visualized by MR using various sequences as well. Using short exposures in CT and/or in MR it is routinely possible to visualize transverse and oblique sinuses, left pulmonic-, inferior aortic-, posterior pericardial-, left pulmonic vein-, right pulmonic-, superior aortic-, right pulmonic vein- and postcaval-recesses. These anatomic structures may be difficult to be seen routinely by ultrasonography.

Pericarditis.
Any thickening of the pericardium above 2-3 mm suggest the presence of an acute inflammatory process if smooth and chronic if irregular.

Pericardial effusion.
In case of enlargement of the pericardial space above 5mm it is possible by analysis of the CT values and/or of the MR signal intensities to distinguish between solid, liquid, semi-liquid and haemorrhagic processes.

Pericardial tamponade.
The CT and MR morphologic and functional patterns of beginning pericardial tamponades are:
- Pericardial effusion around the heart
- Non-visualization of the sub-epicardial space especially around the right heart
- Compression of both especially of the right heart chamber
- Enlargement of the diameters of the inferior and superior caval veins.
Functionally restrictive filling of both ventricles and swinging heart phenomenon are seen.

Constrictive pericardial disease.
The term "constrictive pericardial disease" is applied to inflammatory or non-inflammatory disorders that involve one or both layers of the pericardium and lead to constriction and compression of the underlying cardiac chambers. It is characterized by scarring and/or calcification of the peri- and/or epicardium which thereby looses its compliance and restricts the diastolic filling of the heart.

Total or partial pericardiectomy is the only treatment that may normalize or at least improve cardiac haemodynamics. The current mortality of pericardiectomy ranges from 4-50%. There are nearly no data about haemodynamics improvements in those patients who survived surgery.

A careful systemic analysis of the pericardial and cardiac morphology and function of CT and MR studies enables to distinguish between:
- Global
- Annular
- Right sided
- Left sided
- Effusive
- Occult forms of constrictive pericardial diseases.

Morphologic diagnostic patterns are:
- Thickening and/or calcification of the periepicardium
- Narrowing (tube-like configuration) of one or both ventricles
- Enlargement of one or both atria
- Narrowing of one or both atrio-ventricular grooves
- Enlargement of the diameters of the inferior and superior caval veins.


О журнале Архив Содержание