Accuracy of Cardiac Magnetic Resonance Imaging in Diagnosing Pediatric Cardiac Masses

Beroukhim, Rebecca S.; Ghelani, Sunil J.; Ashwath, Ravi; Balasubramanian, Sowmya; Biko, David M.; Buddhe, Sujatha; Campbell, Michael J.; Cross, Russell R.; Festa, Pierluigi; Griffin, Lindsay; Grotenhuis, Heynric B.; Hasbani, Keren; Hashemi, Sassan; Hegde, Sanjeet; Hussain, Tarique; Jain, Supriya; Kiaffas, Maria; Kutty, Shelby; Lam, Christopher Z.; Liberato, Gabriela; Merlocco, Anthony; Misra, Nilanjana; Mowers, Katie L.; Muniz, Juan Carlos; Nutting, Arni; Parra, David; Patel, Jyoti K.; Perez‐Atayde, Antonio R.; Prasad, Deepa; Rosental, Carlos F; Shah, Amee; Samyn, Margaret M.; Sleeper, Lynn A.; Slesnick, Timothy C.; Valsangiacomo, Emanuela; Geva, Tal

doi:10.1016/j.jcmg.2021.07.010

Cited by 13 publications

(21 citation statements)

References 7 publications

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“…(1) disruption of neighboring tissue and extension of the mass across the pericardium into myocardium, with interruption of epicardial and endocardial contours, (2) increased thickness in comparison with the adjacent myocardial segments, determining hypo/dys/akinesia of a focal myocardial area compared with closest cardiac segments in absence of coronary distribution that could lead to the suspicion of ischemic etiology), (3) mass tissue characterization as defined by qualitative intensity pattern (hypointense, isointense, or hyperintense as compared with normal myocardium) and signal intensity ratio, defined as the signal intensity of the mass relative to the adjacent, uninvolved myocardium, 11,21 presence or absence of contrast first-pass perfusion, EGE or LGE in the mass, (4) presence and severity of pericardial effusion. Case examples are provided in Figure 1.…”

Section: Cardiac Magnetic Resonancementioning

confidence: 99%

“…Compared with echocardiography, CMR allows for high spatial resolution and multiplanar imaging, comprehensively characterizing mass morphology, tissue characterization, blood perfusion, and extracardiac findings. [11][12][13] Several studies have reported a remarkable accuracy of CMR in CMs characterization compared with histology. 12,14,15 However, they are limited due to the small sample size, the underrepresentation of some CMs histotypes, and the lack of a direct comparison between echocardiography and CMR.…”

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confidence: 99%

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Cardiac Magnetic Resonance to Predict Cardiac Mass Malignancy: The CMR Mass Score

Paolisso,

Bergamaschi,

Angeli

et al. 2024

Circ: Cardiovascular Imaging

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BACKGROUND: Multimodality imaging is currently suggested for the noninvasive diagnosis of cardiac masses. The identification of cardiac masses’ malignant nature is essential to guide proper treatment. We aimed to develop a cardiac magnetic resonance (CMR)-derived model including mass localization, morphology, and tissue characterization to predict malignancy (with histology as gold standard), to compare its accuracy versus the diagnostic echocardiographic mass score, and to evaluate its prognostic ability. METHODS: Observational cohort study of 167 consecutive patients undergoing comprehensive echocardiogram and CMR within 1-month time interval for suspected cardiac mass. A definitive diagnosis was achieved by histological examination or, in the case of cardiac thrombi, by histology or radiological resolution after adequate anticoagulation treatment. Logistic regression was performed to assess CMR-derived independent predictors of malignancy, which were included in a predictive model to derive the CMR mass score. Kaplan-Meier curves and Cox regression were used to investigate the prognostic ability of predictors. RESULTS: In CMR, mass morphological features (non-left localization, sessile, polylobate, inhomogeneity, infiltration, and pericardial effusion) and mass tissue characterization features (first-pass perfusion and heterogeneity enhancement) were independent predictors of malignancy. The CMR mass score (range, 0–8 and cutoff, ≥5), including sessile appearance, polylobate shape, infiltration, pericardial effusion, first-pass contrast perfusion, and heterogeneity enhancement, showed excellent accuracy in predicting malignancy (areas under the curve, 0.976 [95% CI, 0.96–0.99]), significantly higher than diagnostic echocardiographic mass score (areas under the curve, 0.932; P =0.040). The agreement between the diagnostic echocardiographic mass and CMR mass scores was good (κ=0.66). A CMR mass score of ≥5 predicted a higher risk of all-cause death ( P <0.001; hazard ratio, 5.70) at follow-up. CONCLUSIONS: A CMR-derived model, including mass morphology and tissue characterization, showed excellent accuracy, superior to echocardiography, in predicting cardiac masses malignancy, with prognostic implications.

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Section: Cardiac Magnetic Resonancementioning

confidence: 99%

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confidence: 99%

Cardiac Magnetic Resonance to Predict Cardiac Mass Malignancy: The CMR Mass Score

Paolisso,

Bergamaschi,

Angeli

et al. 2024

Circ: Cardiovascular Imaging

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“…We have a case of myxofibrosarcoma with multiple metastases soon after surgical resection mimicking myxoma both preoperatively and intraoperatively ( Supplementary Figure 3 ). It may be difficult to differentiate myxomas from malignant tumors or thrombus preoperatively ( 26 , 27 ). PET imaging is sensitive in ruling out malignant tumors, which is costly ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Surgery for Primary Cardiac Tumors in Children: Successful Management of Large Fibromas

Qian

Yang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPediatric primary cardiac tumors (PCTs) are rare. Its clinical features and prognoses are not well defined. The management of asymptomatic patients with cardiac fibromas remains controversial.ObjectiveWe aimed to examine our experience in surgical resection of pediatric PCT, with specific focuses on the management of large fibromas.MethodsThis study included all the children who underwent surgical resection of PCT in our institution between December 2008 and June 2021. The last follow-up was performed between June 1st and August 26th, 2021. Kaplan–Meier method was used to estimate the postoperative survival, freedom from reoperation, event-free survival, and also related risk factors. The tumor volume and volume index (volume divided by body surface area) were measured for cardiac fibromas.ResultsOf the 39 patients with median operative age of 9.5 [interquartile range (IQR): 1.2–16.5] years, 35 (89.7%) had benign tumors (fibromas for 15, myxomas for 13, and others for 7). The length and volume of fibromas were independent of age and symptoms (Ps > 0.05). The fibroma volume index was negatively correlated with age (P = 0.039), with a mean value of 105 ± 70 ml/m2. Of the 15 patients with fibromas, 5 were asymptomatic, 4 received partial resection, 4 required transmural resection, and 4 presented postoperative left ventricular (LV) dysfunction (ejection fraction <50%). During the median follow-up period of 3.1 years and maximum of 12.5 years, adverse events included 2 early and 1 late death, 4 reoperations, 4 tumor recurrences, and 1 LV dysfunction lasting over one year. The 8-year survival, freedom from reoperation, and event-free survival rates were 90.4, 81.8, and 64.2%, respectively. Malignant tumor (P < 0.001) was associated with more adverse events. Transmural resection (P = 0.022) and larger tumor volume index than LV end-diastolic volume (P = 0.046) were risk factors for LV dysfunction following fibromas resection.ConclusionPediatric surgery for PCT can be performed with low mortalities and few adverse events. The size of cardiac fibroma in children relatively decreases with the increase of age. Larger tumor volume index than LV end-diastolic volume index and transmural tumor resection predicts postoperative LV dysfunction.

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“…Currently, CMR is the hottest topic in cardiac mass research. Several retrospective studies have shown that the CMR features demonstrate excellent accuracy for the differentiation of cardiac thrombi from tumors and can be helpful for the distinction of benign and malignant neoplasms (24,(30)(31)(32)(33)(34). A prospective CMR study has demonstrated that tumor size (>3.25 cm), invasion, and first-pass perfusion are useful imaging characteristics in differentiating benign from malignant tumors (35).…”

Section: Discussionmentioning

confidence: 99%

The diagnostic accuracy of contrast echocardiography in patients with suspected cardiac masses: A preliminary multicenter, cross-sectional study

Liu

Ren

Wang

et al. 2022

Front. Cardiovasc. Med.

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Accuracy of Cardiac Magnetic Resonance Imaging in Diagnosing Pediatric Cardiac Masses

Cited by 13 publications

References 7 publications

Cardiac Magnetic Resonance to Predict Cardiac Mass Malignancy: The CMR Mass Score

Cardiac Magnetic Resonance to Predict Cardiac Mass Malignancy: The CMR Mass Score

Surgery for Primary Cardiac Tumors in Children: Successful Management of Large Fibromas

The diagnostic accuracy of contrast echocardiography in patients with suspected cardiac masses: A preliminary multicenter, cross-sectional study

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