Cardiac Magnetic Resonance in the Differentiation of Neoplastic and Nonneoplastic Pericardial Effusion

Abstract

Cardiac magnetic resonance (CMR) is the imaging modality of choice for cardiac tumors in people. Although neoplastic pericardial effusion (PE) carries a poor prognosis, benign idiopathic pericardial effusion does not. Definitive diagnosis is critical for surgical intervention, but currently available diagnostic techniques such as echocardiography and pericardial fluid cytology often are inconclusive. Describe CMR findings associated with PE and determine whether CMR aids in differentiation of benign and neoplastic causes of PE. Eight client-owned dogs with PE diagnosed by transthoracic echocardiography (TTE). CMR was performed with a 1.5 T, including dark blood, steady-state free procession cine, pre- and postcontrast T1-weighted imaging, and delayed inversion recovery prepped imaging. CMR confirmed a cardiac mass and supported suspected tumor type in 4 dogs with suspected hemangiosarcoma. In 1 equivocal TTE case, CMR did not demonstrate a mass, but neoplasia was later diagnosed. In another equivocal case, CMR did not demonstrate a mass but showed findings consistent with a pericardiocentesis complication. In 1 dog without evidence of cardiac neoplasia, abdominal magnetic resonance imaging identified presumptive hepatic and splenic metastases. On reevaluation of the original CMR study, the 2 equivocal cases that were interpreted as tumor negative were reassessed as tumor positive. CMR did not substantially improve diagnosis of cardiac tumors compared with TTE in these 8 cases, but it yielded useful descriptive information regarding extent, anatomic location, and potential tumor type and confirmed that CMR requires extensive additional training for tumor identification.