Dynamic contrast-enhanced MRI for evaluation of cardiac tumors

Abstract

Sir, It is with great interest we read the articles about magnetic resonance imaging (MRI) of cardiac tumors in European Radiology [1–5]. Some authors stress the value of contrast media in the diagnostic workup of cardiac tumors, e.g., for differentiation of tumor and additional thrombi [6]. We would like to emphasize that dynamic contrast-enhanced MRI studies during the first pass possibly allow an even more comprehensive evaluation of tumor perfusion. As these sequences are applied for evaluation of myocardial perfusion, they are of use for tumor perfusion as well. Time-intensity curves can be created with a region-of-interest analysis that enable semiquantitative analysis of perfusion patterns of different cardiac tumors. We performed dynamic contrastenhanced MRI studies in two patients with paracardiac masses next to the right atrium. During intravenous administration of 0.2 mmol gadoliniumdiethylenetriaminepentaacetic acid (GdDTPA) per kilogram of body weight (flow: 5 ml/s), an axial dynamic T1-weighted sequence (single-shot TrueFisp with saturation recovery) was applied (1.5 T Scanner). The electrocardiogram (ECG)gated sequence measured three slices per heart beat over 60 heart beats without disturbing artifacts. The MRI of the 51-year-old man revealed a bulky mass originating from the right atrium with extracardial infiltration (Fig. 1a). Contrast-enhanced dynamic MRI demonstrated a slow increasing time-intensity curve (Fig. 2a). The tumor showed an irregular contrast enhancement. Biopsy revealed an angiosarcoma infiltrating the heart. MRI of a 44-year-old woman revealed a paracardiac mass next to the right atrium that showed a different enhancement pattern (Fig. 1b). The time-intensity curve showed a steep slope during the first pass followed by a washout phase, indicating a highly vascularized stromal tumor (Fig. 2b). Biopsy revealed a Castleman’s lymphoma, which had been considered in our differential diagnosis. We therefore recommend contrastenhanced dynamic MRI for evaluation of cardiac tumors to gain further information about vascularization of tumor tissue. Analysis of timeintensity curves (e.g. up/down slope, time-to-peak) and regional tumor perfusion might be of diagnostic relevance. However, clinical use of firstpass contrast-enhanced MR perfusion techniques in the characterization of cardiac tumors has still to be defined and needs further investigation. Electronic Supplementary Material Supplementary material is available for this article at http://dx.doi.org/10.1007/s00330006-0148-y.