ACCURATE PREOPERATIVE DIAGNOSIS OF PERICARDIAL CONSTRICTION USING CINE COMPUTED-TOMOGRAPHY

Objectives. The purpose of this study was to determine the accuracy of cine computed tomography in the diagnosis of constrictive pericarditi s. Background. Constrictive pericarditis is characterized by abnormali ties of both cardiac structure and function. Accurate diagnosis requir es detection of both a thickened pericardium and abnormal ventricular diastolic filling. At present, no one diagnostic technique has demonst rated sufficient accuracy in this setting. Cine computed tomography is a relatively new cardiac imaging mode with very high time and spatial resolution that has the potential to accurately diagnose constrictive pericarditis. Methods. Twelve consecutive patients were retrospective ly identified who had catheterization findings suggestive of constrict ive physiology, had undergone a cine computed tomographic examination and had pathologic data that delineated the status of the pericardium. Group 1 (with constrictive pericarditis; n = 5) had surgical confirma tion of thickened pericardium and improved clinically after pericardie ctomy. Group 2 (no constrictive pericarditis; n = 7) had cardiomyopath y with normal pericardium. Seven normal volunteers (Group 3) were also studied. Cine computed tomograms were obtained for the entire heart ( 8-mm slices, 17 frames/s, nonionic contrast medium). Pericardial thick ness was measured at 10-degrees intervals at three ventricular levels in each subject. The rapidity of diastolic filling was assessed by cal culating the percent filling fraction in early diastole. Results. Peri cardial thickness was 10 +/- 2 mm (mean +/- SD) in Group 1, 2 +/- 1 mm in Group 2 and 1 +/- 1 mm in Group 3 (p < 0.05, constrictive pericard itis vs. no constrictive pericarditis). Left ventricular filling fract ion was 83 +/- 6% in Group 1, 62 +/- 9% in Group 2 and 44 +/- 5% in Gr oup 3. Right ventricular filling fraction was 93 +/- 5% in Group 1, 62 +/- 14% in Group 2 and 35 +/- 6% in Group 3 (p < 0.05, Group 1 vs. Gr oups 2 and 3). Both indexes provided a clear-cut distinction between p atients with and without constriction. Conclusions. Cine computed tomo graphy simultaneously provides both anatomic and physiologic data that allow accurate preoperative diagnosis of pericardial constriction.