Abstract
It is critical to distinguish between cardiac tumors and thrombi because they require different treatment strategies. Although accurate differentiation of these cardiac masses can be challenging, computed tomography (CT) and magnetic resonance imaging (MRI) are promising tools to improve their diagnosis. This study aimed to assess the diagnostic value of a volume-based quantification strategy using dual-energy CT to differentiate between cardiac tumors and thrombi. We prospectively enrolled 41 patients who had a cardiac mass. All patients underwent electrocardiography gated dual-energy CT. Among them, 28 patients underwent late gadolinium enhancement cardiac MRI. For quantitative analysis, the following parameters of the entire cardiac masses were measured: CT attenuation values in Hounsfield units (HU), iodine concentration (mg/ml), and signal intensity (SI) ratio. A mixed effects model was used to evaluate the significance of differences in mean CT attenuation, mean iodine concentration, and SI ratios between the cardiac tumor and thrombus groups. Diagnostic performance of each parameter was evaluated by constructing a receiver operating characteristics curve. A total of 24 cardiac tumors and 19 cardiac thrombi were analyzed. The mean iodine concentration was significantly higher in tumors than in thrombi (tumors: 2.98 ± 0.23; thrombi: 1.79 ± 0.26, p = 0.002). The diagnostic performance of iodine concentration was better than that of post-contrast HU (area under the curve [AUC]: 0.77 vs. 0.51; p < 0.001), and worse than that of SI ratio (AUC: 0.89; p = 0.04) for differentiation of cardiac tumors and thrombi. Dual-energy CT using volume-based iodine measurements can differentiate between cardiac tumors and thrombi.
Highlights
Cardiac magnetic resonance imaging (MRI) has become a mainstream imaging modality for differential diagnosis of cardiac tumors because it provides an unrestricted field of view and superior tissue characterization without radiation exposure[4,5]
This study aimed to evaluate the diagnostic performance of dual-energy computed tomography (CT) and compare it with those of late gadolinium enhancement (LGE) and CT parameters for the differentiation of cardiac tumors and thrombi
We demonstrated that volume-based iodine measurements using dual-energy CT provide a feasible quantitative parameter for differentiating cardiac tumors from thrombi
Summary
Cardiac magnetic resonance imaging (MRI) has become a mainstream imaging modality for differential diagnosis of cardiac tumors because it provides an unrestricted field of view and superior tissue characterization without radiation exposure[4,5]. A previous study demonstrated that late gadolinium enhancement (LGE) cardiac MRI is a useful non-invasive modality to differentiate a cardiac tumor from a thrombus[6]. It is possible to differentiate iodine from other materials using the material decomposition method[9] This is valuable for differentiating between iodine-enhancing lesions such as cardiac tumors, and non-enhancing lesions such as thrombi. A previous study demonstrated that dual-energy CT was useful for characterizing cardiac masses and differentiating between cardiac tumors and thrombi based on quantification of the iodine content of the mass[8]. The lack of electrocardiography synchronization in dual-energy mode and evaluation of only certain areas of the mass were limitations of the study. The recent development of simultaneous electrocardiography synchronization in rapid kVp-switching dual-energy mode yields good quality CT images without artifacts or image degradation. Newly developed software allows whole tumor segmentation, which enables whole-tumor evaluation
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