Optimal timing of late gadolinium enhancement imaging in patients undergoing CMR for suspected pericarditis: the later the better?

Abstract Funding Acknowledgements Type of funding sources: None. Background Pericarditis is frequently encountered in daily clinical practice and accounts for about 5% of chest pain hospital admissions [1]. Although the diagnosis of pericarditis can be established by clinical criteria, cardiovascular magnetic resonance (CMR) imaging is increasingly used to evaluate concomitant myocardial involvement and/or to exclude other disease entities. Besides well-known morphologic findings like pericardial effusion, thickening or adhesion, pericardial late gadolinium enhancement (LGE) imaging has been demonstrated to be the most sensitive surrogate of pericarditis [2]. Purpose While there is a lot of data regarding the optimal timing of LGE for the detection of myocardial damage, optimal timing of LGE for the detection of pericarditis is unknown. In the recent advent of rapid high-throughput CMR protocols, high diagnostic accuracy needs to be maintained not only for myocardial diseases, but also for the assessment of the pericardium. Methods We present a case series comparing pericardial contrast enhancement in rapid routine LGE images versus LGE images acquired following a longer waiting time after Gadolinium injection (gadoteridol). Results After a longer than rapid clinical routine waiting time, we observed more prominent pericardial signal enhancement in the setting of pericarditis. This effect is most likely explained by different pericardial Gadolinium distribution kinetics compared to the myocardium. Conclusion Consequently, this observation should be taken into account when imaging patients with suspected pericarditis and may warrant further evaluation. Figure: Routine LGE timing (top row) versus delayed LGE timing (bottom row) in 4 patients with pericarditis undergoing CMR Exemplary LGE images in the top row were acquired routinely after ∼10 min. from contrast administration (0,15mmol/Kg), whereas same LGE slices in the bottom row were additionally acquired after a delayed waiting time (∼20 min.) from contrast injection (0,15mmol/Kg). Pericardial LGE was more prominent in delayed LGE imaging compared to routine LGE imaging.