CMR in Assessment of Cardiac Masses

Esposito, Antonio; Cobelli, Francesco De; Ironi, Gabriele; Marra, Paolo; Canu, Tamara; Mellone, Renata; Maschio, Alessandro Del

doi:10.1016/j.jcmg.2013.11.008

Cited by 17 publications

(12 citation statements)

References 2 publications

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“…Tissue vascularization can be seen on first-pass perfusion (FPP) imaging, whereas late gadolinium enhancement (LGE) of the lesion helps in characterizing fibrotic components. 6,7 A broad-based differential for a cardiac mass includes thrombus, benign tumor, and malignant tumor. Because differentiation of tumor from thrombi is well established by CMR, we focus this study on use of CMR for differentiation between benign and malignant tumors.…”

mentioning

confidence: 99%

Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging

Kassi

Polsani

Schutt

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Background: The purpose of this analysis is to describe the differences in cardiac magnetic resonance characteristics between benign and malignant tumors, which would be helpful for surgical planning.Methods: This was a prospective cohort study of 130 patients who underwent cardiac magnetic resonance imaging for evaluation of a suspected cardiac mass. After excluding thrombi and tumors without definitive diagnosis, 66 tumors were evaluated for morphologic features and tissue composition.Results: Of the 66 patients, 39 (59.0%) had malignant tumors and 27 (41.0%) had benign tumors. Patients with malignant tumors were younger when compared with those with benign tumors (age 51 years [42.8-60.0] vs 65 years [60.0-71.0] median). Malignant tumors more often demonstrated tumor invasion (69% vs 0% P<.001) and were more often associated with pericardial effusion (41% vs 7.4% P ¼ .004). Presence of first-pass perfusion (100% vs 33% P <.001) and late gadolinium enhancement (100% vs 59.2%, P <.001) were significantly higher in malignant tumors. In logistic regression modeling, tumor invasion (P <.001) and first-pass perfusion (P < .001) were independently associated with malignancy. Furthermore, using classification and regression tree analysis, we developed a decision tree algorithm to help differentiate benign from malignant tumors (diagnostic accuracy $90%). The algorithm-weighted cost of misclassifying a malignant tumor as benign was twice that of classifying a benign tumor as malignant.Conclusions: Our study demonstrates that cardiac magnetic resonance imaging is a useful noninvasive method for differentiating malignant from benign cardiac tumors. Tumor size, invasion, and first-pass perfusion were useful imaging characteristics in differentiating benign from malignant tumors.

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confidence: 99%

Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging

Kassi

Polsani

Schutt

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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“…Cardiac MRI plays an important role in the assessment of cardiac masses. It allows multi-parametric characterization of cardiac masses using topography, morphology, SI, or pattern of enhancement of cardiac tumors 3 , 10 , 11 . However, MRI has several disadvantages, including a long scanning time, and it cannot be used to examine patients with implanted metallic devices.…”

Section: Discussionmentioning

confidence: 99%

“…Iodine quantification appears more accurate than standard enhancement measurements when the volume of interest (VOI) covers the entire mass. Although cardiac MRI is a reference modality for evaluation of cardiac masses 10 , 11 , dual-energy CT can play a complementary role to that of MRI in cases when MRI is not available or in which echocardiography or conventional CT results are inconclusive.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of a Whole Cardiac Mass Using Dual-Energy Computed Tomography: Comparison with Conventional Computed Tomography and Magnetic Resonance Imaging

Hong

Hur

Han

et al. 2018

Sci Rep

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It is critical to distinguish between cardiac tumors and thrombi because they require different treatment strategies. Although accurate differentiation of these cardiac masses can be challenging, computed tomography (CT) and magnetic resonance imaging (MRI) are promising tools to improve their diagnosis. This study aimed to assess the diagnostic value of a volume-based quantification strategy using dual-energy CT to differentiate between cardiac tumors and thrombi. We prospectively enrolled 41 patients who had a cardiac mass. All patients underwent electrocardiography gated dual-energy CT. Among them, 28 patients underwent late gadolinium enhancement cardiac MRI. For quantitative analysis, the following parameters of the entire cardiac masses were measured: CT attenuation values in Hounsfield units (HU), iodine concentration (mg/ml), and signal intensity (SI) ratio. A mixed effects model was used to evaluate the significance of differences in mean CT attenuation, mean iodine concentration, and SI ratios between the cardiac tumor and thrombus groups. Diagnostic performance of each parameter was evaluated by constructing a receiver operating characteristics curve. A total of 24 cardiac tumors and 19 cardiac thrombi were analyzed. The mean iodine concentration was significantly higher in tumors than in thrombi (tumors: 2.98 ± 0.23; thrombi: 1.79 ± 0.26, p = 0.002). The diagnostic performance of iodine concentration was better than that of post-contrast HU (area under the curve [AUC]: 0.77 vs. 0.51; p < 0.001), and worse than that of SI ratio (AUC: 0.89; p = 0.04) for differentiation of cardiac tumors and thrombi. Dual-energy CT using volume-based iodine measurements can differentiate between cardiac tumors and thrombi.

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“…Sarcomas are usually isointense on T1 weighted imaging, hyperintense on T2 weighted imaging and demonstrate heterogeneous contrast enhancement. Angiosarcomas are heterogeneous in T1 and T2 weighted imaging and show heterogeneous contrast enhancement [3].…”

Section: Perspectivementioning

confidence: 99%

Dressler's pericarditis and an unusual vascular lesion of the myocardium

Abraham¹,

Daryani²

2019

J Cardio Case Rep

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Description of clinical presentationAn 80-year-old gentleman presented initially to a hospital in Scotland with a week long history of chest pain and shortness of breath. He proceeded to a coronary angiogram which showed severe mid vessel left anterior descending artery (LAD) stenosis, chronic total occlusion (CTO) of the left circumflex distal to the first oblique marginal branch (OM1), and mild disease in the right coronary artery (RCA). He underwent percutaneous intervention to the LAD. He was subsequently admitted to our Hospital in South London three weeks later with pleuritic chest pain, shortness of breath, productive cough and pyrexia.

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CMR in Assessment of Cardiac Masses

Cited by 17 publications

References 2 publications

Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging

Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging

Quantitative Analysis of a Whole Cardiac Mass Using Dual-Energy Computed Tomography: Comparison with Conventional Computed Tomography and Magnetic Resonance Imaging

Dressler's pericarditis and an unusual vascular lesion of the myocardium

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