FDG-PET/CT may be helpful in making a presumptive diagnosis of malignancy, especially in nondiagnostic pericardial effusion with relatively high-risk pericardiocentesis, or may guide selection of an optimal biopsy site with a potential high yield of disease. However, infectious processes such as tuberculosis can show increased FDG uptake mimicking malignancy, which limits FDG-PET/CT utility in differentiation between benign and malignant pericardial disease [105]. MRI Heart Function and Morphology MRI is typically an adjuvant test when echocardiographic data are ambiguous or inconclusive for constriction [102]. MRI can provide reliable depiction of pericardial thickening, typically with dark blood imaging, with prognostic value for patients eventually progressing to surgical resection. Furthermore, cardiac MR, real-time cine imaging with free breathing can suggest constrictive pathophysiology where the septum shifts toward the left ventricle during early inspiration. A model combining pericardial thickness and relative interventricular septal excursion provided the best overall performance in prediction of constrictive pericarditis in a surgical series of patients (C statistic, 0.98, 100% sensitivity, 90% specificity) [106], although shallow breaths or vigorous inspiration may result in false negative or false positive results, respectively [107]. LGE can reveal the presence and severity of pericardial inflammation [102], with histologic changes corresponding to MRI appearance. MRI may define the extent of associated myocarditis when there is a concern of myocardial involvement and echocardiography is inconclusive [107]. MRI can provide incremental value to evaluate the presence and severity of active pericardial inflammation in patients with constrictive pericarditis [107]. Pericardial delayed hyperenhancement quantitative assessment on cardiac MRI can be a helpful prognostic tool in the care of
Dyspnea Suspected Cardiac Origin Ischemia Already Excluded . FDG-PET/CT may be helpful in making a presumptive diagnosis of malignancy, especially in nondiagnostic pericardial effusion with relatively high-risk pericardiocentesis, or may guide selection of an optimal biopsy site with a potential high yield of disease. However, infectious processes such as tuberculosis can show increased FDG uptake mimicking malignancy, which limits FDG-PET/CT utility in differentiation between benign and malignant pericardial disease [105]. MRI Heart Function and Morphology MRI is typically an adjuvant test when echocardiographic data are ambiguous or inconclusive for constriction [102]. MRI can provide reliable depiction of pericardial thickening, typically with dark blood imaging, with prognostic value for patients eventually progressing to surgical resection. Furthermore, cardiac MR, real-time cine imaging with free breathing can suggest constrictive pathophysiology where the septum shifts toward the left ventricle during early inspiration. A model combining pericardial thickness and relative interventricular septal excursion provided the best overall performance in prediction of constrictive pericarditis in a surgical series of patients (C statistic, 0.98, 100% sensitivity, 90% specificity) [106], although shallow breaths or vigorous inspiration may result in false negative or false positive results, respectively [107]. LGE can reveal the presence and severity of pericardial inflammation [102], with histologic changes corresponding to MRI appearance. MRI may define the extent of associated myocarditis when there is a concern of myocardial involvement and echocardiography is inconclusive [107]. MRI can provide incremental value to evaluate the presence and severity of active pericardial inflammation in patients with constrictive pericarditis [107]. Pericardial delayed hyperenhancement quantitative assessment on cardiac MRI can be a helpful prognostic tool in the care of