Incremental value of cardiac magnetic resonance for the evaluation of cardiac tumors in adults: experience of a high volume tertiary cardiology centre
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To assess the value of cardiac magnetic resonance imaging (CMR) in evaluating cardiac tumours in a tertiary cardiology centre. Between 2004 and 2014, 125 patients (pts.) from a total of 17000 who received a CMR examination in our institution were referred with the suspicion of cardiac tumours. A dedicated protocol was used that included standard cine SSFP acquisitions as well as tissue characterization using T1 and T2 black-blood (T1 BB and T2 BB respectively) with and without fat suppression, perfusion of the structure and late gadolinium enhancement. Patients’ files were retrospectively analysed and data related to clinical status, results from other examinations (echocardiography), therapeutic approach and histology results, when performed, were collected. In 65 pts., a diagnosis of cardiac tumour was reached. 45 Pts had a biopsy. The CMR examination was concordant with the histology results in 35 (76%) pts. superior to that showed by echocardiography, 26 (58%) pts., p = 0.03. Forty-two (65%) pts. had a benign tumour and 23 (35%) a malignant process. Myxoma was the most frequent benign tumour, 27 (65%) and cardiac metastases were the most frequent form of malignancies, 21 (91%), with B cell non-Hodgkin lymphoma being the most frequent one, 4 (19%). Benign tumours were mostly located in the left atrium, 27 (64%) versus 6 (26%), p = 0.007, whereas malignant tumours had a predilection for the right atrium und left ventricle [11 (48%) vs. 3 (7%), p = 0.001 and 8 (35%) vs. 3 (7%), p = 0.03]. All benign cardiac tumours were single and did not show signs of infiltration. Conversely, malignant cardiac tumours were larger (43 ± 35 vs. 24 ± 16, p = 0.007) with a significant proportion (65%) showing myocardial infiltration. Pts with malignant cardiac tumours had a higher proportion of LGE (82 vs. 60%, p = 0.05) and exhibited more frequently an isointense signal in T1 BB images (78 vs. 61%, p = 0.04). Both groups showed similar proportion of perfusion and signal intensity in the T2 BB acquisitions (p = NS). CMR is a valuable tool in evaluating cardiac tumours, proving superior to echocardiography in establishing the type of cardiac tumour.
KeywordsCardiac tumour Myxoma Cardiac metastasis Tissue characterisation Late gadolinium enhancement
Cardiac magnetic resonance imaging
First pass perfusion
Late gadolinium enhancement
- T1 BB
T1 weighted black blood images
- T2 BB
T2 weighted black blood images
We thank our MR-technicians Angela Stöcker-Wochele, Birgit Hoerig, Daniel Helm (Heidelberg).
SG designed the study, gathered the data and wrote the draft of the manuscript, DM performed the echocardiographic examinations and offered intellectual input, AO gathered the data and reviewed the manuscript, SB performed the CMR examinations and offered intellectual input, FA performed the CMR examinations, SS created the patients’ database and reviewed the manuscript, JR performed the examinations and offered intellectual input, PF performed the CMR examinations, MA performed the anatomopathological examination and reviewed the manuscript, SS offered intellectual input and reviewed the manuscript, HK offered intellectual input and reviewed the manuscript, GK designed and coordinated the study, offered intellectual input and reviewed the final version of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to declare.
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