Pericardial effusion MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.


MRI allow assessment of the entire chest and detection of associated abnormalities in the mediastinum, lungs and adjacent structures. MRI also delineate more precisely the spacial distribution of pericardial effusion in complex pericardial collections. It may be very useful in the investigation of the presence and extension of neoplastic disease.

Magnetic Resonance Imaging

A pericardial effusion is black on spin echo images and in contrast is bright on gradient echo images. Small to moderate sized pericardial effusion occupy the space anterior to the right ventricle and are usually 5 mm or greater. A large pericardial effusion is often circumferential.

Insight into the composition of the pericardial effusion can be gleaned based upon the following characteristics:

  • Transudates: low signal on T1-weighted images but high signal on T2-weighted and gradient echo images.
  • Exudates: Intermediate signal on both types of sequences.
  • Hemorrhagic effusions: Wide range of signal intensity on spin-echo sequences that is dependent upon the age of the effusion.


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