Cardiac MRI Improves Diagnosis of Pericarditis, Suggests Study
Australia: Researchers have found in a retrospective analysis that cardiac magnetic resonance imaging (MRI) has significant clinical utility in diagnosing pericarditis. The findings suggest that cardiac MRI can enhance diagnostic accuracy, particularly in patients with inconclusive clinical or conventional imaging findings, supporting more timely and appropriate management.
Pericarditis is commonly diagnosed using clinical criteria, including characteristic chest pain, a pericardial rub, electrocardiographic changes, and pericardial effusion. However, these features are often transient or absent, making diagnosis challenging. To assess the added value of cardiac magnetic resonance (CMR) imaging, researchers led by Sebastian Hasslacher from Concord Repatriation General Hospital, Sydney, Australia, evaluated its role in identifying pericardial inflammation.
The retrospective cohort study, published in the BMJ journal Heart, reviewed consecutive patients referred for CMR evaluation of suspected pericarditis or myopericarditis at a tertiary hospital in Sydney between 2010 and 2024. Patients were classified according to the presence or absence of pericardial late gadolinium enhancement (LGE), a marker of active pericardial inflammation, and their clinical, laboratory, and imaging findings were compared.
The key findings were as follows:
- Of 2,530 patients referred for CMR, 88 underwent imaging for suspected pericarditis or myopericarditis.
- Forty-three patients (49%) had CMR-confirmed pericarditis, while 45 patients (51%) showed no evidence of active pericardial inflammation on CMR.
- Among patients with CMR-confirmed pericarditis, 30% did not meet the 2015 European Society of Cardiology (ESC) clinical diagnostic criteria, indicating that CMR identified cases that would otherwise have been missed.
- Conversely, 47% of patients with negative CMR findings met the conventional clinical diagnostic criteria, suggesting that CMR may help avoid overdiagnosis in some patients.
- Higher C-reactive protein (CRP) levels and the presence of pericardial effusion were associated with positive CMR findings and more extensive pericardial inflammation.
- A CRP level above 50 mg/L demonstrated moderate predictive value for identifying CMR-positive pericarditis, with 56% sensitivity and 84% specificity.
- Patients with CMR-confirmed pericarditis who did not fulfill standard clinical criteria were more likely to have subacute or non-idiopathic disease, despite showing similar degrees of pericardial inflammation on imaging.
The findings indicate that cardiac MRI can both confirm pericardial inflammation in patients who do not meet conventional diagnostic criteria and exclude significant inflammation in many patients initially diagnosed on clinical grounds alone. This may improve diagnostic confidence and help guide appropriate treatment decisions.
The authors concluded that cardiac MRI provides important incremental value in the evaluation of suspected pericarditis. They also noted that elevated CRP levels and the presence of pericardial effusion may help identify patients most likely to benefit from CMR assessment. Overall, the study supports incorporating cardiac MRI into the diagnostic workup of selected patients with suspected pericarditis, particularly when clinical findings are equivocal or inconsistent.
Reference:
Hasslacher S, Kritharides L, Yu C, et al. Added value of cardiac magnetic resonance to clinical diagnostic criteria in the diagnosis of pericarditis: a retrospective cohort study. Heart 2026;112:855-862.
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