Multiple annotated MRI images showing findings in constrictive pericarditis:
1. One frame of the grid cine sequence: The green arrow points to the gridline through the pericardium. The red arrow points to the gridline through the myocardium. The left ventricle is in early systole, but notice how the pericardium and myocardium are "tethered" at the angle of the line rather than becoming discontinuous.
2. Delayed post contrast short axis image shows delayed enhancement in the pericardium around the left and right ventricles (green arrows). The myocardium does not show delayed enhancement (red arrow).
3. Another view of thickened pericardium (green arrow). The red arrow points to normal myocardium.
4. This image shows how the edge artifact in an SSFP sequence can help highlight thickened and tethered pericardium. The inner edge artifact (light blue arrow) indicates the interface between the myocardium and the epicardial space/epicardial fat (bright). The outer edge artifact (dark blue arrow) is the interface between the pericardium and the epicardial fat. In some regions (small blue arrow) the edge disappears.The pericardium and the myocardium are continuous at these regions, with obliteration of the epicardial space.