First experiences with contrast-enhanced first-pass MR perfusion imaging in patients with primary, benign cardiac masses and tumour-like lesions

Abstract

The aim of this study was to evaluate the diagnostic value of contrast-enhanced first-pass perfusion MRI in patients with suspected cardiac masses and tumour-like lesions. Twenty patients underwent contrast-enhanced first-pass saturation-recovery steady-state-free-precession perfusion MRI in addition to clinical MRI. Eleven diagnostic parameters were analysed blinded in consensus by three observers: localisation (paracardiac/mural/intracavitary), malignancy (benign/malignant) and first-pass enhancement pattern (homogeneous/heterogeneous as well as non-perfused/hypoperfused/iso-perfused/ hyperperfused). The results were compared to combined references comprising histology, cytology, medical and surgical reports, echocardiography, chest X-ray, coronary angiography and regular MRI. Also, we analysed if additional first-pass perfusion confirmed, changed or reduced the number of differential diagnoses compared to clinical MRI. All cardiac masses or tumour-like lesions were correctly localised and scored as benign lesions. For homogeneous perfused lesions the sensitivity, specificity, positive and negative predictive value was 94/100/100/67%, 100/94/67/100% for heterogeneous perfused lesions, 92/100/100/88% for non-perfused, 100/94/75/100 for hypoperfused, 100/100/100/100% for hyperperfused and for isoperfused lesions. In 17/2/1 cases perfusion MRI confirmed, reduced or increased the number of potential differentials. First-pass perfusion MRI provides valuable information in patients with benign cardiac masses or tumour-like lesions. Further experience is needed to underline these preliminary observations.

Hypereosinophilic Syndrome: A rare case of Loeffler’s endocarditis documented in cardiac MRI

“…The diagnostic work-up of this unique case suggests that first-pass perfusion MRimaging ensures to differentiate between endocardium, myocardium and thrombus in suspected cardiac manifestation of HES (Loeffler's syndrome). The use of firstpass perfusion MRI allows to differentiate perfused and enhancing myocardium from poorly vascularised and hypoenhancing thrombus or eosinophilic infiltrate [5,6] and therefore is not only instrumental to establish the diagnosis, but may also have strong impact on therapeutic management.…”

MR first pass perfusion of benign and malignant cardiac tumours—significant differences and diagnostic accuracy

“…However, if specific cardiac tumoural features are lacking, tissue characterisation may remain difficult. Therefore, diagnostic information that can be derived from MR first pass perfusion imaging, as shown by Mohrs et al [7], who focused on benign cardiac masses and thrombi, may be crucial. However, data dealing with Table 3 Mean values and standard deviation of the signal enhancement and the slope of the signal enhancement curve of all benign and malignant cardiac tumours, the myocardium and tumour tissue in relation to normal myocardium.…”

“…These techniques allow for multislice coverage (3-5 slices/heart beat) and multiplanar imaging to assess various aspects of the area or tissue of interest depending on its size and localisation. The use and value of MR perfusion imaging in cardiac tumours has already been demonstrated in benign lesions [7].…”

Elusive Cardiac Angiosarcoma in a Young Pregnant Female: Rare Presentation With Fatal Outcome

“…MRI of the heart has become the reference imaging method for evaluation of suspected cardiac tumors. Mohrs et al reported 100% sensitivity, 100% specificity, 100% positive and negative predictive values for hyper-perfused and for iso-perfused primary cardiac lesions [ 32 ]. Tissue biopsy remains the diagnostic gold standard.…”