Assessment Of Cardiac Masses Research Articles

Fibroma Cardíaco: Seguimento a Longo Prazo por Ressonância Magnética Cardíaca

Background: Primary cardiac neoplasms are rare, and a correct diagnosis is essential to planning the most appropriate treatment. Objective: To demonstrate the role of cardiac magnetic resonance imaging (CMR) in the assessment, diagnosis, and follow-up of cardiac fibroma. Case report: Female 21-year-old patient with a myocardial mass detected on echocardiogram. CMR confirmed a diagnosis of cardiac fibroma. The patient chose to be followed up, and her condition remained stable after six years. Discussion: Cardiac fibromas are the second most common neoplasm in children and young people. On CMR, it is characterized by intense and homogeneous delayed enhancement. CMR plays an important role in the assessment of cardiac masses.

Assessment of Cardiac Masses by Cardiac Magnetic Resonance Imaging: Histological Correlation and Clinical Outcomes.

BackgroundCardiac magnetic resonance imaging (CMR) provides useful information for characterizing cardiac masses, but there are limited data on whether CMR can accurately distinguish benign from malignant lesions. We aimed to describe the distribution and imaging characteristics of cardiac masses identified by CMR and to determine the diagnostic accuracy of CMR for distinguishing benign from malignant tumors.Methods and ResultsWe examined consecutive patients referred for CMR between May 2008 and August 2013 to identify those with a cardiac mass. In patients for whom there was histological correlation, 2 investigators blinded to all data analyzed the CMR images to categorize the mass as benign or malignant. For benign masses, readers were also asked to specify the most likely diagnosis. Benign masses were defined as benign neoplastic or non‐neoplastic. Malignant masses were defined as primary cardiac or metastatic. Of 8069 patients (mean age: 58±16 years; 55% female) undergoing CMR, 145 (1.8%) had a cardiac mass. In most cases (142, 98%), there was a known cardiac mass before the CMR study. Among 145 patients with a cardiac mass, 93 (64%) had a known history of malignancy. Among 53 cases that had histological correlation, 25 (47%) were benign, 26 (49%) were metastatic, and 2 (4%) were malignant primary cardiac masses. Blinded readers correctly diagnosed 89% to 94% of the cases as benign versus malignant, with a 95% agreement rate (κ=0.83).ConclusionsAlthough CMR can be highly effective in distinguishing benign from malignant lesions, pathology remains the gold standard in accurately determining the type of mass.

Masas cardiacas: multimodalidad-resonancia magnética cardiaca

Cardiac magnetic resonance plays a fundamental role in the diagnosis, definition, and assessment of cardiac masses, due to its wide field of vision, contrast resolution, versatility in image planes, and the unique capacity to help in the discrimination of different tissue characteristics. Due to all this, several consensus statements have positioned cardiac magnetic resonance as first line imaging technique in the study of cardiac masses.

Evaluation and Management of Cardiac Tumors.

Our purpose is to discuss the importance of multimodality imaging in the assessment of cardiac tumors and management. We have compiled a recent review of the scientific literature and embedded our clinical pathways and recommendations based on data and clinical experience. The use of contrast echocardiography in the assessment of cardiac masses has been shown to be helpful in distinguishing tumor from thrombus. Deformation imaging of cardiac tumors has been shown to differentiate better rhabdomyomas from fibromas in pediatric patients. Cardiac MRI (CMR) appears to be helpful in determining whether cardiac tumors are benign or malignant by identifying presence of infiltration, uptake of contrast in first pass perfusion and gadolinium enhancement. Patients with evidence of cardiac metastases by CMR show similar survival to stage IV cancer without cardiac metastases. In our institution, we use a standardized approach for the evaluation of cardiac masses, which includes multimodality imaging in the appropriate clinical context. The autotransplantation surgical technique has shown some promise in improving survival in patients with primary cardiac sarcomas. In our institution, we do not routinely recommend anticoagulation for "tumor-thrombus" in renal cell carcinoma due to risk of bleeding from primary tumor. Cardiac masses are often found incidentally, but sometimes can present with cardiovascular symptoms due to obstruction and valvular dysfunction, which may prompt imaging. It is important to determine whether the mass is a normal variant, imaging artifact, vegetation, thrombus, or tumor. Transthoracic echocardiography is ideally suited to be the initial imaging modality because of the portability, wide availability, lack of radiation, and relatively low cost. The gold standard cardiac imaging technique to distinguish tumor from thrombus is contrast enhanced CMR with prolonged inversion time. Advantages of CMR when compared to echocardiography regarding characterization of cardiac tumors are as follows: larger field of view, better spatial resolution, better tissue characterization, lack of attenuation, and ability to image at any prescribed plane. Primary and secondary cardiac tumors have particular characteristics in echocardiography and CMR. Imaging of cardiac tumors plays an important role in establishing a diagnosis and in planning management.

Cardiac and pericardial tumors: A potential application of positron emission tomography-magnetic resonance imaging.

Cardiac and pericardial masses may be neoplastic, benign and malignant, non-neoplastic such as thrombus or simple pericardial cysts, or normal variants cardiac structure can also be a diagnostic challenge. Currently, there are several imaging modalities for diagnosis of cardiac masses; each technique has its inherent advantages and disadvantages. Echocardiography, is typically the initial test utilizes in such cases, Echocardiography is considered the test of choice for evaluation and detection of cardiac mass, it is widely available, portable, with no ionizing radiation and provides comprehensive evaluation of cardiac function and valves, however, echocardiography is not very helpful in many cases such as evaluation of extracardiac extension of mass, poor tissue characterization, and it is non diagnostic in some cases. Cross sectional imaging with cardiac computed tomography provides a three dimensional data set with excellent spatial resolution but utilizes ionizing radiation, intravenous iodinated contrast and relatively limited functional evaluation of the heart. Cardiac magnetic resonance imaging (CMR) has excellent contrast resolution that allows superior soft tissue characterization. CMR offers comprehensive evaluation of morphology, function, tissue characterization. The great benefits of CMR make CMR a highly useful tool in the assessment of cardiac masses. (Fluorine 18) fluorodeoxygluocse (FDG) positron emission tomography (PET) has become a corner stone in several oncological application such as tumor staging, restaging, treatment efficiency, FDG is a very useful imaging modality in evaluation of cardiac masses. A recent advance in the imaging technology has been the development of integrated PET-MRI system that utilizes the advantages of PET and MRI in a single examination. FDG PET-MRI provides complementary information on evaluation of cardiac masses. The purpose of this review is to provide several clinical scenarios on the incremental value of PET and MRI in the evaluation of cardiac masses.

Cardiac tumors: echo assessment.

Cardiac tumors are exceedingly rare (0.001–0.03% in most autopsy series). They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1) thrombus or vegetations are the most likely etiology, (2) cardiac tumors are mostly secondary and (3) primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.

Assessment of cardiac mass from tagged magnetic resonance images.

Tagged and cine magnetic resonance imaging (tMRI and cMRI) techniques are used for evaluating regional and global heart function, respectively. Measuring global function parameters directly from tMRI is challenging due to the obstruction of the anatomical structure by the tagging pattern. The purpose of this study was to develop a method for processing the tMRI images to improve the myocardium-blood contrast in order to estimate global function parameters from the processed images. The developed method consists of two stages: (1) removing the tagging pattern based on analyzing and modeling the signal distribution in the image's k-space, and (2) enhancing the blood-myocardium contrast based on analyzing the signal intensity variability in the two tissues. The developed method is implemented on images from twelve human subjects. Ventricular mass measured with the developed method showed good agreement with that measured from gold-standard cMRI images. Further, preliminary results on measuring ventricular volume using the developed method are presented. The promising results in this study show the potential of the developed method for evaluating both regional and global heart function from a single set of tMRI images, with associated reduction in scan time and patient discomfort.

Integrated 18F-FDG PET/MR imaging in the assessment of cardiac masses: a pilot study.

The objective of the present study was to evaluate whether integrated (18)F-FDG PET/MR imaging could improve the diagnostic workup in patients with cardiac masses. Twenty patients were prospectively assessed using integrated cardiac (18)F-FDG PET/MR imaging: 16 patients with cardiac masses of unknown identity and 4 patients with cardiac sarcoma after surgical therapy. All scans were obtained on an integrated 3-T PET/MR device. The MR protocol consisted of half Fourier acquisition single-shot turbo spin-echo sequence, cine, and T2-weighted images as well as T1-weighted images before and after injection of gadobutrol. PET data were acquired simultaneously with the MR scan after injection of 199 ± 58 MBq of (18)F-FDG. Patients were prepared with a high-fat, low-carbohydrate diet in a period of 24 h before the examination, and 50 IU/kg of unfractionated heparin were administered intravenously 15 min before (18)F-FDG injection. Cardiac masses were diagnosed as follows: metastases, 3; direct tumor infiltration via pulmonary vein, 1; local relapse of primary sarcoma after surgery, 2; Burkitt lymphoma, 1; scar/patch tissue after surgery of primary sarcoma, 2; myxoma, 4; fibroelastoma, 1; caseous calcification of mitral annulus, 3; and thrombus, 3. The maximum standardized uptake value (SUVmax) in malignant lesions was significantly higher than in nonmalignant cases (13.2 ± 6.2 vs. 2.3 ± 1.2, P = 0.0004). When a threshold of 5.2 or greater was used, SUVmax was found to yield 100% sensitivity and 92% specificity for the differentiation between malignant and nonmalignant cases. T2-weighted hyperintensity and contrast enhancement both yielded 100% sensitivity but a weak specificity of 54% and 46%, respectively. Morphologic tumor features as assessed by cine MR imaging yielded 86% sensitivity and 92% specificity. Consent interpretation using all available MR features yielded 100% sensitivity and 92% specificity. A Boolean 'AND' combination of an SUVmax of 5.2 or greater with consent MR image interpretation improved sensitivity and specificity to 100%. In selected patients, (18)F-FDG PET/MR imaging can improve the noninvasive diagnosis and follow-up of cardiac masses.

CMR in the Assessment of Cardiac Masses: Primary Malignant Tumors

CARDIAC MAGNETIC RESONANCE (CMR) PLAYS AN IMPORTANT ROLE IN THE ASSESSMENT OF CARDIAC tumors, because it combines high contrast and spatial resolution with a panoramic view of the heart and surrounding structures and an unmatched ability to characterize tissues. So, CMR assessment is frequently

CMR in Assessment of Cardiac Masses: Primary Benign Tumors

Cardiac magnetic resonance (CMR) plays an important role in the assessment of cardiac tumors, because it combines high contrast and spatial resolution with a panoramic view of the heart and surrounding structures and an unmatched ability to characterize tissues. So, CMR assessment with dedicated

The role of imaging in the assessment of cardiac masses and metastases

Primary tumors are a rare phenomenon, while cardiac metastasis is rather more frequent. Cardiac masses and metastasis are usually first detected by echocardiography, which allows to describe and detail the size, the insertion, the mobility, the relation with cardiac and non-cardiac structure, and local invasion. Myocardial contrast echocardiography is able to improve tissue characterization of the masses. Transthoracic echocardiography evaluation is generally completed by cardiac magnetic resonance and computed tomography scanner, which give some important and additional information on tissue characteristics and tissue property such as vascularity and fibrosis.

Diagnostic performance of CMR and transthoracic echocardiography in clinical evaluation of cardiac masses with histopathological correlation

Echocardiography is the preferred initial imaging method for assessment of cardiac masses. However, CMR, with its excellent tissue characterization and wide field of view, can provide unique information in the evaluation of cardiac masses. Our objective was to identify CMR and echocardiographic parameters that predict the presence of tumor or malignancy in biopsy proven cardiac masses and to assess the potential added value of CMR to echocardiography in the evaluation of cardiac masses. Methods We retrospectively identified 50 patients (50% male, mean age 46 ± 17 years) referred for CMR evaluation of cardiac mass who underwent biopsy or resection with histopathological diagnosis. Echocardiography was performed prior to CMR in 44/50 (88%) of the cases. Echocardiographic and CMR characteristics of the mass were evaluated for their predictive value in distinguishing tumor versus non-tumor and malignant versus non-malignant masses based on histopathology as the gold standard. Tumors were classified as any benign or malignant (primary or metastatic) neoplasm found in or around the heart while non-tumors were classified as any other mass (eg, thrombus) found in this area.Binary logistic regression and ROC curves were used to assess the diagnostic utility of these imaging characteristics alone and in combination for prediction of tumor or malignancy. Wilcoxon rank-sum test was used to compare the number of times a correct pathologic diagnosis was provided by each imaging study.

Lipoma at the right atrioventricular groove

The assessment of cardiac masses is currently based on ‘Multimodality imaging’ approach. A 53-year-old man, with a clinical history of dilated cardiomyopathy, was admitted to San Raffaele Hospital in order to remove a previous infected implantable cardioverter defibrillator (ICD)-cardiac resynchronization therapy device with ultimate …

Cardiac hamartoma: Magnetic resonance and computed tomographic imaging

We present a case of a cardiac hamartoma, which is an exceedingly rare, pathologically benign, primary cardiac tumour. We illustrate the imaging appearance of this lesion on CT and MRI, and demonstrate the complementary roles that these two modalities play in the assessment of cardiac masses, specifically in the characterization of fatty content and calcifications. Finally, we offer a discussion of how a cardiac hamartoma may be differentiated from other, more common cardiac masses.

Assessment of cardiac masses: magnetic resonance imaging versus transthoracic echocardiography

The purpose of this study is to compare the role of magnetic resonance imaging (MRI) with transthoracic echocardiography (TTE) for characterization of cardiac masses. Twenty-three patients were examined with a 1.5T MRI Scanner and TTE for the evaluation of suspected intracardiac masses. MRI examinations were performed with a protocol of steady cine imaging, HASTE and 3D IR-FLASH sequence after administration of gadolinium chelate. All patients were examined with MRI within a period of 1-2 weeks after TTE. According to the results of MRI, 15 patients underwent cardiac surgery. All of the operated patients were proven to have cardiac tumors with no false positive diagnosis on MRI. In 3 of 8 unoperated patients who were diagnosed to have cardiac tumors on TTE, cardiac thrombi were identified on MRI. Two patients with Eustachian valve in the right atrium on MRI were misinterpreted as having cardiac masses on TTE. In one patient with known renal cancer, metastases were diagnosed within the myocardium on MRI. TTE demonstrated a mass in the left atrium in one patient with a history of myxoma operation, whereas MRI was able to show the paracardiac extension of the mass into pulmonary veins and lung metastases, which are indicators of malignant transformation. In one patient, a mediastinal mass compressing the left atrium on MRI was misinterpreted as an intracavitary lesion with TTE. Contrast enhanced MRI is a noninvasive method superior to TTE in diagnosis, differentiation, and detection of extension of cardiac masses.

Evaluation of intracardiac masses using three-dimensional echocardiography

Echocardiography is the most common noninvasive tool used in the assessment of intracardiac masses. Real-time three-dimensional echocardiography expands the diagnostic capabilities of cardiac ultrasound in the assessment of the location, composition, size, and relationship to adjacent structures of intracardiac masses. The optimal characterization of the anatomy as well as the superior definition of cardiac function makes this the technology of choice in the assessment of cardiac masses.

Right atrial angiosarcoma and electrocardiogram-gated cardiac computed tomography: a case report

Primary cardiac tumors are quite rare and most of these tumors are benign. In this report, a patient presented with chest distress and shortness of breath after activity. Echocardiography of other hospital showed a hyperechoic right atrial mass. Electrocardiogram-gated cardiac computed tomography (ECG-Gated CT) of our hospital provided accurate information about the site and extent of the tumor, and the involvement of neighboring structures, even about the malignant nature of the lesion. The pathological study indicated angiosarcoma. The role of ECG-Gated CT in the assessment of cardiac masses and tumors was discussed. Cardiac tumors are extremely rare and can be divided into benign and malignant lesions. Myxomas are the most common type of cardiac benign tumor, while angiosarcomas are the most common type of cardiac malignant tumor. Imaging studies play an important role in the diagnosis of cardiac angiosarcomas. Echocardiogram, computed tomography (CT) and magnetic resonance imaging (MRI) are the most common imaging studies for tumors evaluation. However, the precise tumor location is often difficult to evaluate precisely on the basis of two-dimensional source images. We conducted ECG-gated cardiac CT examination with 3D reconstruction for preoperative assessment in a patient with a angiosarcoma arising in the right atrium.

Cardiac MRI is Complementary to Echocardiography in the Assessment of Cardiac Masses

Despite the fact that the incidence of cardiac tumors is low, the prompt evaluation and adequate intervention of these is highly important. Although most tumors of the heart are considered histologically benign, there are significant risks associated with these "benign" tumors. These are associated with significant morbidity and mortality due to obstruction of blood flow, alterations of conduction, propagation of arrhythmias, and thromboembolism, depending on their size, location, and nature. With the advent of noninvasive imaging modalities--traditionally echocardiography; but more recently using cross-sectional imaging with cardiac computed tomography and magnetic resonance imaging--cardiac tumors can be optimally assessed providing a greater opportunity for curative treatments by cardiothoracic surgery.

Late Enhancement of a Left Ventricular Cardiac Fibroma Assessed With Gadolinium-Enhanced Cardiovascular Magnetic Resonance

A 4-year-old patient was referred to our department and underwent gadolinium-enhanced cardiovascular MR (CMR) because of a suspected left ventricular mass. The infant was referred for an ECG before dental surgery; ECG revealed negative T waves in leads D1, AVL, V4, V5, and V6. Echocardiography showed a heterogeneous mass of the left ventricular lateral wall inside the pericardial space, 4.0×2.0 cm in size, with reduced lateral wall motion. The global left ventricular function was normal. CMR was performed under sedation with a 1.5-T magnet (Gyroscan …

The use of computed tomography in the assessment of cardiac masses

Computed tomography has been found to be a useful tool in the evaluation of cardiac masses. It can be most effacious in the detection of a lesion and in the delineation of its size and location, as well as the demonstration of its relationships to intra- and extracardiac structures. It can be especially useful in areas of the heart where echocardiography can be difficult. This is particularly true for the left atrium, where lesions such as small thrombi can be missed.