El Roumi Joseph, Schenone Aldo L, Cremer Paul, Wang Tom Kai Ming, Klein Allan
Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Division of Cardiology, Montefiore Einstein Center for Heart and Vascular Care. Albert Einstein College of Medicine, Bronx, New York, USA.
Eur J Clin Invest. 2025 Sep;55(9):e70067. doi: 10.1111/eci.70067. Epub 2025 May 23.
In the era of precision medicine, cardiac multimodality imaging plays a vital role in diagnosing, managing, and monitoring pericarditis. This condition, often marked by inflammation and recurrent episodes, requires precise imaging techniques to guide diagnosis and therapeutic decisions.
We carefully reviewed the medical literature for high-quality data regarding the use of multimodality imaging in pericarditis and the precious value of the novel concept of imaging-guided therapy.
While echocardiography remains the cornerstone for detecting pericardial effusion and evaluating hemodynamics, its limited ability to characterize inflammation has driven the use of advanced modalities such as cardiac magnetic resonance imaging (CMR), cardiac computed tomography (CT), and positron emission tomography (PET). CMR offers superior visualization of pericardial inflammation through late gadolinium enhancement, aiding in identifying patients who may benefit from targeted anti-inflammatory therapies. CT imaging, with its high spatial resolution, aids in detecting pericardial calcifications and thickening, particularly in constrictive pericarditis. PET, often combined with CT, is a valuable tool for quantifying metabolic activity, allowing the detection of active inflammation, particularly in complex or refractory cases. Multiple imaging targets have been identified as essential biomarkers to confirm the inflammatory phenotype, assess treatment response, and monitor for complications.
Considering the inherent limitations of each imaging modality, the integration of imaging findings with clinical and biomarker data may aid clinicians in tailoring therapy according to different clinical scenarios and better stratification of patients who may benefit from IL-1 blockade. This review explores the valuable role of cardiac multimodality imaging-guided therapy in managing pericarditis.
在精准医学时代，心脏多模态成像在诊断、管理和监测心包炎方面发挥着至关重要的作用。这种疾病通常以炎症和反复发作的症状为特征，需要精确的成像技术来指导诊断和治疗决策。
我们仔细查阅了医学文献，以获取有关多模态成像在心包炎中的应用以及成像引导治疗这一新颖概念的宝贵价值的高质量数据。
虽然超声心动图仍然是检测心包积液和评估血流动力学的基石，但其在表征炎症方面的能力有限，这促使人们使用心脏磁共振成像（CMR）、心脏计算机断层扫描（CT）和正电子发射断层扫描（PET）等先进模态。CMR通过延迟钆增强能够更好地显示心包炎症，有助于识别可能从靶向抗炎治疗中获益的患者。CT成像具有高空间分辨率，有助于检测心包钙化和增厚，特别是在缩窄性心包炎中。PET通常与CT结合使用，是量化代谢活性的宝贵工具，能够检测到活动性炎症，尤其是在复杂或难治性病例中。多个成像靶点已被确定为确认炎症表型、评估治疗反应和监测并发症的重要生物标志物。
考虑到每种成像模态的固有局限性，将成像结果与临床和生物标志物数据相结合，可能有助于临床医生根据不同的临床情况调整治疗方案，并更好地对可能从白细胞介素-1阻断治疗中获益的患者进行分层。本综述探讨了心脏多模态成像引导治疗在心包炎管理中的重要作用。
