Constrictive pericarditis is caused by adhesions between the visceral and parietal layers of the pericardium and progressive pericardial fibrosis that restricts diastolic filling of the heart. Later on, the thickened pericardium may calcify. Despite a better understanding of the pathophysiologic basis of the imaging findings in constrictive pericarditis and the recent advent of magnetic resonance imaging (MRI) technology, which has dramatically improved the visualization of the pericardium, the diagnosis of constrictive pericarditis remains a challenge in many cases. In patients with clinical suspicion of underlying constrictive pericarditis, the most important radiologic diagnostic feature is abnormal pericardial thickening, which can be shown readily by computed tomography (CT) and especially by MRI, and is highly suggestive of constrictive pericarditis. Nevertheless, a thickened pericardium does not always indicate constrictive pericarditis. Furthermore, constrictive pericarditis can occur without pericardial thickening.

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Cardiovascular magnetic resonance (CMR) imaging plays an essential role in the evaluation and follow-up of adult congenital heart disease (ACHD), providing safe, high-resolution imaging of some of the most complex anatomies encountered. Unlimited by acoustic windows and capable of tissue characterization, CMR is devoid of ionizing radiation and provides superior three-dimensional spatial resolution to transthoracic echocardiography and superior temporal resolution to computed tomography, making it the gold standard for various cardiac and great vessel imaging indications in ACHD. In this state-of-the art review, we provide an overview of CMR examination methods and detail the various approaches and classical findings in the more common forms of ACHD. Although this review touches upon technical aspects of CMR imaging in ACHD, it is primarily geared toward the adult congenital caregiver (i.e., clinical, interventional, or surgical), highlighting relevant practical considerations. To enhance the clinical utility of this review, numerous examples with intraoperative correlates are provided to highlight our imaging approaches for various defects. As CMR image acquisition may be time consuming and requires patient collaboration (e.g., intermittent breath holding), a systemic approach is required to maximize efficiency. A thorough knowledge of ACHD anatomy and natural history is essential in maximizing image interpretation. Proficient scanning is further enabled by clearly outlined study objectives with prior documentation of interventional and surgical procedures, where applicable.

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