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Incremental value of cardiac magnetic resonance for the evaluation of cardiac tumors in adults: experience of a high volume tertiary cardiology centre

  • Sorin Giusca
  • Derliz Mereles
  • Andreas Ochs
  • Sebastian Buss
  • Florian André
  • Sebastian Seitz
  • Johannes Riffel
  • Philipp Fortner
  • Mindaugas Andrulis
  • Stefan Schönland
  • Hugo A. Katus
  • Grigorios KorosoglouEmail author
Original Paper

Abstract

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.

Keywords

Cardiac tumour Myxoma Cardiac metastasis Tissue characterisation Late gadolinium enhancement 

Abbreviations

CMR

Cardiac magnetic resonance imaging

FPP

First pass perfusion

IAS

Interatrial septum

LGE

Late gadolinium enhancement

LA

Left atrium

LV

Left ventricle

RA

Right atrium

RV

Right ventricle

T1 BB

T1 weighted black blood images

T2 BB

T2 weighted black blood images

Notes

Acknowledgements

We thank our MR-technicians Angela Stöcker-Wochele, Birgit Hoerig, Daniel Helm (Heidelberg).

Author contributions

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.

Supplementary material

10554_2017_1065_MOESM1_ESM.mp4 (2.9 mb)
Supplementary Video 1. CMR of a patient with cardiac myxoma (same as shown in Figure 4). Cine SSFP acquisition in 4 chamber view – note the insertion of the cardiac myxoma at the interatrial septum and its mobility in the left atrium (MP4 3006 KB)
10554_2017_1065_MOESM2_ESM.mp4 (11.2 mb)
Supplementary Video 2. CMR of a patient with cardiac metastasis (same as shown in Figure 5). The uptake of the contrast agent in the cardiac metastasis can be appreciated during first pass perfusion acquisitions. (MP4 11484 KB)
10554_2017_1065_MOESM3_ESM.mp4 (3.7 mb)
Supplementary Video 3. CMR of a patient with cardiac thrombus (same as illustrated in Figure 6). Cine SSFP acquisition in a modified right ventricular view (Video 3). Note that the cardiac thrombus inserts on the roof of the right atrium and protrudes into the right ventricle during diastole. (MP4 3757 KB)
10554_2017_1065_MOESM4_ESM.mp4 (4.8 mb)
Supplementary Video 4. First pass perfusion acquisition of the cardiac thrombus demonstrates absence of contrast uptake (Video 4). (MP4 4889 KB)

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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Sorin Giusca
    • 1
  • Derliz Mereles
    • 1
  • Andreas Ochs
    • 1
  • Sebastian Buss
    • 1
  • Florian André
    • 1
  • Sebastian Seitz
    • 1
  • Johannes Riffel
    • 1
  • Philipp Fortner
    • 1
  • Mindaugas Andrulis
    • 2
  • Stefan Schönland
    • 3
  • Hugo A. Katus
    • 1
  • Grigorios Korosoglou
    • 1
    Email author
  1. 1.Department of CardiologyUniversity of HeidelbergHeidelbergGermany
  2. 2.Institute of PathologyUniversity of HeidelbergHeidelbergGermany
  3. 3.Department of HaematologyUniversity of HeidelbergHeidelbergGermany

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