Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging

Abstract

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.

Cardiac Biventricular Metastasis From Renal Cell Carcinoma

“…CMR is the best imaging modality for evaluating cardiac masses and differentiating inflammation from cardiac metastases. Moreover, it can distinguish between thrombus and cardiac tumors and is an invaluable non-invasive method for differentiating malignant and benign cardiac tumors [13]. The imaging characteristics that are useful for the differentiation are tumor size, invasion of the free wall or adjacent structure, and first-pass perfusion to determine tumor's vascularity [13].…”

Commentary: When the hoofbeats are a zebra

“…We find cardiac magnetic resonance imaging particularly helpful, because it can establish the presence or absence of perfusion in most cases. 4 A cardiac magnetic resonance imaging study in this case might or might not have shown perfusion, because hematomas have no perfusing vessels, but there did appear to be some sinuses of perfusion in the mass. If clinical information and imaging suggest that this is a potential tumor, then the treatment pathway should also be of interest to cardiac surgeons.…”

Non-Malignant Cardiac Tumors

“…While the imaging characteristics, as described above, of myxomas are often diagnostic, unusual appearing masses might prompt further imaging to rule-out other tissue types. The differential diagnosis for such masses includes teratomas (rare), lipomas, angiosarcomas, rhabdomyomas, and rhabdomyosarcomas [18]. Distinguishing characteristics often consist of intramyocardial tumor invasion on imaging.…”