VALUE OF RADIONUCLIDE VENTRICULOGRAPHY AN D MAGNETIC-RESONANCE-IMAGING IN CONSTRICTIVE PERICARDITIS

In suggestive clinical presentations, the diagnosis of constrictive pe ricarditis is confirmed by the haemodynamic findings of impaired ventr icular filling (adiastole). In this study of 15 patients with pure con strictive pericarditis, the diagnosis value of two non-invasive techni ques little used in this indication until now was examined: radionucli de ventriculography (RV) and magnetic resonance imaging (MRI). The RV provides a << functional >> diagnosis through the analysis of global a nd segmental left ventricular filling whilst MRI provides anatomical d etails of the pericardial thickening. Diastolic dysfunction on RV pres ented as an increased early diastolic filling time as shown by a short ening of the interval to third filling T1/3R (p < 0.0001), an increase d peak diastolic E wave velocity (p < 0.01) and early onset (p < 0.001 ), increased one third (FR 1/3) and mid (FR 1/2) diastolic filling fra ctions (p < 0.01) and of the E wave velocity to maximal systolic eject ion velocity (S) ration (p < 0.01). The atrial contribution to filling in end diastole decreased (NS). Asynchronous filling, shown by disper sion of the times of onset of segmental early diastolic E peak velocit ies (DELTAtE) or of one third diastolic filling DELTA T1/3R, decreased . Seven patients underwent MRI. Pericardial thickening was present in all patients. The pericardium varied from 6 to 14 mm thick (normal 2.5 +/- 0.7 mm), without any systolodiastolic variation. The thickening w as seen as a dark low intensity signal, indicating the fibro-calcific character of the tissues. Sagittal and coronal views clearly demonstra ted the non-uniformity of pericardial thickening. These results show t hat RV and MRI are complementary and synergistic and provide the funct ional and anatomic evidence required for the diagnosis of constrictive pericarditis.