MR Imaging of Cardiac Tumors

Abstract

Magnetic resonance (MR) imaging is an important tool in the evaluation of cardiac neoplasms. T1-weighted, T2-weighted, and gadolinium-enhanced sequences are used for anatomic definition and tissue characterization, whereas cine gradient-echo imaging is used to assess functional effects. Recent improvements in pulse sequences for cardiac MR imaging have led to superior image quality, with reduced motion artifact and improved signal-to-noise ratio and tissue contrast. Although there is some overlap in the MR imaging appearances of cardiac tumors, particularly of primary malignancies, differences in characteristic locations and features should allow confident differentiation between benign and malignant tumors. Indicators of malignancy at MR imaging are invasive behavior, involvement of the right side of the heart or the pericardium, tissue inhomogeneity, diameter greater than 5 cm, and enhancement after administration of gadolinium contrast material (as a result of higher tissue vascularity). Concomitant pericardial or pleural effusions are rare in benign processes but occur in about 50% of cases of malignant tumors. MR imaging offers improved resolution, a larger field of view, and superior soft-tissue contrast compared with those of echocardiography, suggesting that knowledge of the MR imaging features of cardiac neoplasms is important for accurate diagnosis and management.

Pericardial Masses, Cysts and Diverticula: A Comprehensive Review Using Multimodality Imaging

“…Metastatic tumors of the pericardium are more common than primary tumors, with estimated incidence from autopsy studies ranging widely from 20 to 1000 times more likely. [8][9][10][11] Due to the rarity of these tumors, initial data were in the form of case reports and more recently as larger case series. Presentation is variable and often patients may be asymptomatic with pericardial involvement initially only detected at time of autopsy or on cross-sectional imaging in the current era.…”

“…27 Lipomas are slow-growing, typically asymptomatic, encapsulated collections of adipose cells which are thought to arise from the atrio-ventricular grooves. 10,15 Teratomas are benign germ cell tumors found in infants and children with evidence of all three germ layers, calcifications and cystic components on pathology and imaging. They are often right-sided tumors which may cause compressive symptoms of adjacent structures including the right atrium, superior vena cava, pulmonary artery or aortic root.…”

“…28 Fibromas are solid masses most commonly found in children composed of fibroblasts which commonly have areas of calcification and rarely areas of necrosis or cystic change. 10,28 Hemangiomas are vascular masses of either capillary, cavernous or arteriovenous etiology which may present in any age group, and when found in the pericardium are often of the cavernous type and arise from the visceral pericardium. [28][29][30] Lymphangiomas may resemble cysts, however they usually have thicker walls, are multilocular and contain lymphocytes and blood vessels.…”

Multimodal Cardiovascular Imaging of Cardiac Tumors

“…Myxomas display low to iso-density on non-contrast-enhanced CT (14,18). Calcification is more common in right atrial masses and is clearly shown on CT. On MRI, myxomas typically display low intensity on T1WI and high intensity on T2WI; however, they sometimes exhibit heterogeneous signal intensity due to mucoid degeneration or hemorrhaging (21). Faint contrast enhancement is seen in the arterial phase, and mild contrast enhancement is observed in the delayed phase (Fig.…”

Primary malignant cardiac tumors: Surgical results

“…Nowadays, ECG-gated computed tomography provides better definition of tumor structure and invasion margins and shows its relation with the coronary arteries. 3 However, magnetic resonance imaging (MRI) with late gadolinium enhancement is currently the method of choice to diagnose and stage cardiac tumors, both local and metastatic. In fact, in a few cases of metastasizing cardiac melanoma, the paramagnetic nature of melanin has led to the type of tumor being identified by MRI.…”