Correlation of transesophageal ultrasound of the pericardium with computed tomography.

Objective: In this study, we assess the sensitivity and specificity of ultrasound and computed tomography (CT) for pericardial effusion and constrictive pericarditis.

Materials And Methods: This was a retrospective, institutional review board-approved, and health insurance privacy accountability act compliant study performed at a single tertiary center over a 10-year period (2001-2011) for patients who had clinical symptoms of pericarditis and had undergone both cardiac CT imaging and transesophageal echocardiogram (TEE) in a span of 2 weeks.

Inclusion Criteria: Inclusion criteria included patients with clinical symptoms of pericarditis, pericardial thickness measuring more than 2 mm on CT, and patients who had both cardiac CT imaging and TEE performed within 2 weeks.

Exclusion Criteria: Exclusion criteria included patients with pericardial thickness measuring 2 mm or less on CT, no TEE, TEE not done within 2 weeks of the thoracic CT, and calcified pericardium on CT.Computed tomographic images were retrospectively reviewed by 2 radiologists who were unaware of the TEE findings. Pericardial effusion on CT was deemed present if there was obliteration of the fat plane in the left pulmonic recess.

Statistical Analysis: Statistical analysis was performed using the R statistical environment (Rstat). Intraobserver and interobserver variability was estimated using Cohen κ- statistic (Cohen).

Results: Forty-three cases constituted the study population (28 men and 15 women; mean age, 55 years; age range, 22-82 years). Twenty-one patients had pathologic confirmation of pericarditis.The findings for CT and TEE were discrepant in 10 cases. Intraobserver variability Cohen κ statistic was 0.855. Interobserver variability Cohen κ statistics were 0.54 and 0.49.

Conclusions: Computed tomography is sensitive to pericardial effusion and pericardial thickening, whereas TEE seems insensitive to isolated pericardial thickening.