Diagnostic value of cardiac magnetic resonance for the differential diagnosis of thrombus vs tumor

Abstract

Background Correct differentiation of a cardiac tumor from a thrombus remains important in clinical practice as the prognosis and therapeutic approach vary substantially. Techniques such as echocardiography may have limitations due to reduced image quality and poor tissue characterization. Cardiac magnetic resonance (CMR) has emerged as a promising tool in this regard; however, studies assessing its value are scarce. Methods We retrospectively analyzed the CMR of patients with a definite cardiac mass. Thrombus was defined as a noninfiltrating mass that fulfilled any of the following criteria: a) adjacent to an akinetic or dyskinetic myocardial segment (typically infarcted) or central catheter, b) located in the atrial appendage in patients with atrial fibrillation, c) experienced a significant reduction in size under anticoagulation therapy, or d) had surgical and/or pathological confirmation. Tumor was defined as a mass that did not fulfill any of the above criteria plus a) was infiltrative, or b) located in the left aspect of the fossa ovalis with typical features of myxoma, or c) had surgical and/or pathological confirmation. Mass features on common CMR sequences (cine image, T1-weighted [T1w] and T2 weighed [T2w] spin-echo, contrast first pass perfusion, post-contrast TI scout, and late gadolinium enhancement (LGE)) were analyzed. Categorical data were summarized as frequencies and percentages, and continuous variables were expressed as mean ± SD. Difference in CMR characteristics between thrombi and tumors were compared by Chi-square, Fisher’ so r t-student tests as appropriate. A two sided P-value of <0.05 was considered significant. Results