Magnetic Resonance Imaging Evaluation of Cardiac Masses

Abstract

BackgroundCardiac tumors are extremely rare; however, when there is clinical suspicion, proper diagnostic evaluation is necessary to plan the most appropriate treatment. In this context, cardiovascular magnetic resonance imaging (CMRI) plays an important role, allowing a comprehensive characterization of such lesions.ObjectiveTo review cases referred to a CMRI Department for investigation of cardiac and paracardiac masses. To describe the positive case series with a brief review of the literature for each type of lesion and the role of cardiovascular magnetic resonance imaging in evaluation.MethodsBetween August 2008 and December 2011, all cases referred for CMRI with suspicion of tumor involving the heart were reviewed. Cases with positive histopathological diagnosis, clinical evolution or therapeutic response compatible with the clinical suspicion and imaging findings were selected.ResultsAmong the 13 cases included in our study, eight (62%) had histopathological confirmation. We describe five benign tumors (myxomas, rhabdomyoma and fibromas), five malignancies (sarcoma, lymphoma, Richter syndrome involving the heart and metastatic disease) and three non-neoplastic lesions (pericardial cyst, intracardiac thrombus and infectious vegetation).ConclusionCMRI plays an important role in the evaluation of cardiac masses of non-neoplastic and neoplastic origin, contributing to a more accurate diagnosis in a noninvasive manner and assisting in treatment planning, allowing safe clinical follow-up with good reproducibility.

Primary Cardiac Sarcoma

“…[25][26][27] Echocardiography is the initial test and has been the cornerstone to diagnose cardiac tumors; however, computed tomography and cardiac magnetic resonance imaging are being increasingly used to allow better tissue characterization, precise location, and preoperative planning. [28][29][30][31][32] …”

The Role of CMR Imaging for the Differential Diagnosis of Right-Sided Intracardiac Masses: A Case Report

“…The CMR imaging could take the first place in the differentiation of the intracardiac masses, when the TTE and/or TEE methods are inadequate [18]. This noninvasive, cost-effective imaging technique has a larger field of view and differentiates various conditions of the heart due to the ability to visualize tissue composition, to assess flow measurements, cardiac function, stress and rest perfusion of the heart, applying the early and late gadolinium enhancement and new developments as T1/T2 mapping [15][16][17][18]. Discussing about patients with a history of cancer, the CMR imaging has major advantages in distinguishing tumors from thrombi because of the opportunity to assess the perfusion of the mass, which is the component of the neoplastic lesions and enhances after gadolinium contrast application whereas the hematic thrombi has no vascular appearance [27].…”

“…Consequently, the differential diagnosis between tumor, metastasis, thrombi/embolus and normal cardiac structures is essenti-al for patients with cancer. At this point of view, the TTE or TEE becomes the limited diagnostic tool because of the incapacity to visualize the tissue composition whereas the cardiovascular magnetic resonance (CMR) imaging is highly valuable diagnostic method in the assessment of cardiac masses due to its larger field of view of both intracardiac and extracardiac structures, the multiplanar 3-dimensional imaging with the excellent spatial resolution and the opportunity to discriminate various tissue types based on the CMR properties [15][16][17][18]. Moreover, W. Staab et al recommended to apply CMR as the first line imaging tool to detect or to rule out intracardiac masses and thrombi in specific clinical cases [18].…”

The Role of Magnetic Resonance Imaging and Cardiac Computed Tomography in the Assessment of Left Atrial Anatomy, Size, and Function

“…Myxomas represent the most common benign tumours in LA, followed by rhabdomyomas and fibromas. Myxomas are typically mobile, oval masses attached to the atrial septum, and they tend to have heterogeneous CMR signal with a typical LGE pattern [ 10 , 11 ]. Less frequent LA mass findings include malignant tumours such as lymphomas and sarcomas, and nonneoplastic lesions like thrombi, infectious vegetations, and pericardial cysts [ 11 ].…”