CMR Constriction vs Restriction — EECC MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: A — Pericardial thickening (≥4 mm), septal bounce (respirophasic ventricular interdependence), real-time cine showing septal shift with respiration, and pericardial LGE (inflammation) — all favour constriction over restriction
Differentiating constrictive pericarditis from restrictive cardiomyopathy is one of the most challenging diagnostic dilemmas in cardiology. CMR provides several key distinguishing features for constriction: (1) pericardial thickening (≥4 mm — though 20% of constriction has normal thickness); (2) pericardial LGE (active inflammation suggesting transient/reversible constriction); (3) real-time free-breathing cine showing septal bounce (respirophasic ventricular interdependence — the hallmark of constriction); (4) tubular-shaped ventricles with dilated atria. Restrictive cardiomyopathy shows: (1) normal pericardial thickness; (2) myocardial abnormalities (elevated T1/ECV in amyloidosis, low T1 in Fabry, iron loading in haemochromatosis); (3) no septal bounce. Cardiac catheterisation with simultaneous RV/LV pressure recording remains the gold standard for equivocal cases.
Reference: ESC (2025): Myocarditis/Pericarditis Guidelines; SCMR Recommendations