Pericardium plays a crucial role in securing the heart within the mediastinum. Pericardial diseases include a variety of clinical entities such as acute pericardial disease, effusion, cardiac tamponade, and constrictive pericarditis. Cardiac computed tomography (CT), with its high spatial resolution, offers detailed visualization of pericardial structures and aids in diagnosing and assessing pericardial thickening, calcifications, and effusions. Additionally, CT provides valuable information about pericardial fluid characteristics. Cardiac magnetic resonance (CMR) complements CT in the evaluation of pericardial diseases as it offers superior tissue characterization and functional assessment. Both CT and MRI enable the quantification of the epicardial adipose tissue (EAT) and the pericardial adipose tissue (PAT), which have emerged as important biomarkers of cardiometabolic health. As visceral fat depots, they are associated with insulin resistance and diabetes, while volumetric quantification of EAT and PAT can predict adverse events and noncardiac mortality and, as a result, holds the potential to revolutionize risk stratification algorithms and improve patient care.