Diagnostic value of contrast enhanced echocardiography in cardiac masses

Abstract

Objective To investigate the value and accuracy of contrast enhanced echocardiography in the diagnosis of cardiac masses. Methods A total of 66 patients who were treated at Tongji Hospital of Huazhong University of Science and Technology from March 2013 to May 2018 were enrolled in the present study. Cardiac masses were discovered by echocardiography in each of the patients, and conventional echocardiography and contrast enhanced echocardiography were performed in all of the patients. The enhancement levels of cardiac masses and adjacent myocardium on contrast images were evaluated by visual inspection and quantitative analysis. On visual inspection, a cardiac mass with no enhancement was diagnosed as thrombus, a mass with partial and lesser enhancement than adjacent myocardium was diagnosed as benign tumor, while a mass with complete enhancement was diagnosed as malignant tumor. By quantitative analysis, the difference between a mass and adjacent myocardium (ΔA) was calculated using time-signal intensity curves. The sensitivity, specificity, and accuracy of ΔA in tissue characterization of cardiac masses were evaluated by ROC curve analysis. The final diagnoses of all cardiac masses were identified by validation methods. Results Using the gold standard methods, of the 66 patients, 15 were diagnosed with thrombi, 23 diagnosed with benign tumors, and 28 with malignant tumors. The sensitivity, specificity, and accuracy of visual inspection in differentiating thrombi, benign tumors, and malignant tumors were 100%, 100%, and 100%, 91%, 100%, and 97%, and 100%, 95%, and 97%, respectively. The sensitivity, specificity, and accuracy of ΔA in differentiating thrombi from other masses were 93%, 100%, and 95%, respectively (cutoff value=-3.21dB, AUC=0.978). The sensitivity, specificity, and accuracy of ΔA in differentiating malignant tumors from other masses were 100%, 97%, and 98%, respectively (cutoff value=0.45dB, AUC=0.997). Conclusion Both visual inspection and quantitative analysis of contrast enhanced echocardiography have a high sensitivity and specificity in differentiating between cardiac thrombi, benign tumors, and malignant tumors. Key words: Echocardiography; Ultrasound contrast; Heart neoplasms; Thrombus