ESCEuropean Heart Joumal-Cardiovascular Imaging(2023)00.1-16REVIEWEuropean Society https://doiorg/10.1093/ehjci/jead092of CardiologyCardiac magnetic resonance imaging ofpericardial diseases:a comprehensive guideAlexios S.Antonopoulos 1.2*t,Apostolos Vrettos 3,Emmanouil Androulakis4,Christina Kamperou',Charalambos Vlachopoulos 1,Konstantinos Tsioufis1,Raad Mohiaddin 4,and George Lazaros 111st Cardiology Department.Hpporkration Hospital Nationaland Kapodistrian University of Athens.114 Vas Sofias Avenue 11527 Athens Greece:Clinical Experimental Surgery&TranslationalResearch Center.BiomedicalResearch Foundation of the Academy ofAthens.4Soranou Efesiou Street.11527.Athens GreeceDepartment ofCardiology.St Bartholomew'sHospital,Barts Health NHS Trust.London.UK:and CMR Unit.Royal Brompton Hospital Royal Brompton and Harefield NHS Foundation Trust Chelsea LondonRecelved 3 February 2023:edtorial decision 18 Aprl 2023Cardiac magnetic resonance(CMR)imaging has been established as a valuable diagnostic tool in the assessment of pericardial diseases by providing8information on cardiac anatomy and function,surrounding extra-cardiac structures,pericardial thickening and effusion,characterization of pericar-dial effusion,and the presence of active pericardial inflammation from the same scan.In addition,CMR imaging has excellent diagnostic accuracy forthe non-invasive detection of constrictive physiology evading the need for invasive catheterization in most instances.Growing evidence in the fieldsuggests that pericardial enhancement on CMR is not only diagnostic of pericarditis but also has prognostic value for pericarditis recurrence,although such evidence is derived from small patient cohorts.CMR findings could also be used to guide treatment de-escalation or up-titrationin recurrent pericarditis andselecting patients most likelyto benefit from novel treatments such as anakinra and rilonacept.This article is an overviewof the CMR applications in pericardial syndromes as a primer for reporting physicians.We sought to provide a summary of the clinical protocols usedand aninterpretation of the major CMR findings in the setting ofpericardial diseases.We also discuss points that are less well clear and delineate thestrengths and weak points of CMR in pericardial diseases2Keywordspericardial diseases.pericarditis.cardiac magnetic resonance late gadolinium enhancement.constrictionIntroduction(LGE)afteran episode ofacute pericarditis remains less clear,the valueof CMR in pericardial diseases is currently unanimously accepted and itsPericardial diseases most commonly involve inflammatory processes ofuse is growing.During the COVID-19 pandemic,CMR has emerged asinfectious and non-infectious aetiology in response to local or systemicthe primary decision tool for COVID-19 and vaccine-related pericardialstimuli.12 Pericardial response to disease leads to the manifestation ofor myocardial injury.s173358distinctive signs and symptoms.The typical and common pericardialIn this
