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Differentiation of Cardiac Masses by Cardiac Magnetic Resonance Imaging

Abstract

Purpose of the Review

The purpose of this study is to review the utility of cardiac magnetic resonance (CMR) imaging in diagnosing and differentiating among different cardiac masses.

Recent Findings

Recent advances in tissue characterization have made CMR the noninvasive modality of choice in differentiating cardiac masses. Greater spatial resolution, sophisticated tissue characterization, and multiple imaging planes to assess intra-cavitary masses enable CMR to perform a “virtual biopsy” of the mass.

Summary

Cardiac tumors are rare but reporting of cardiac masses on noninvasive testing as computed tomography (CT) or echocardiogram is common. Cardiac masses can widely range from a normal structure of the heart, also known as “pseudo-mass,” to cardiac thrombus, to the benign and malignant primary and secondary tumors of the heart. CMR represents an advanced noninvasive method to differentiate between cardiac masses given its spatial and tissue characterization ability. It has become a key testing tool in the diagnostic algorithm of evaluating cardiac masses.

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Abbreviations

MRI:

Magnetic resonance imaging

LGE:

Late gadolinium enhancement

FPP:

First-pass perfusion

EGE:

Early gadolinium enhancement

References

  1. 1.

    Lam KY, Dickens P, ACL C. Tumors of the heart: A 20-year experience with a review of 12 485 consecutive autopsies. Arch Pathol Lab Med. 1993.

  2. 2.

    Mc Allister HA. Primary tumors and cysts of the heart and pericardium. Curr Probl Cardiol. 1979.

  3. 3.

    Roberts WC. Primary and secondary neoplasms of the heart. Am J Cardiol. 1997.

  4. 4.

    Pennell DJ, Sechtem UP, Higgins CB, et al. Clinical indications for cardiovascular magnetic resonance (CMR): consensus panel report. Eur Heart J. 2004.

  5. 5.

    Hundley WG, Bluemke DA, Finn JP, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 Expert consensus document on cardiovascular magnetic resonance. A report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol. 2010.

  6. 6.

    Dujardin KS, Click RL, Oh JK. The role of intraoperative transesophageal echocardiography in patients undergoing cardiac mass removal. J Am Soc Echocardiogr. 2000.

  7. 7.

    Motwani M, Kidambi A, Herzog BA, Uddin A, Greenwood JP, Plein S. MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology. 2013;268:26–43.

  8. 8.

    Bruce C. Cardiac tumours: diagnosis and management. Heart. 2011;97:151–60.

  9. 9.

    Butany J, Nair V, Naseemuddin A, Nair GM, Catton C, Yau T. Cardiac tumours: diagnosis and management. Lancet Oncol. 2005.

  10. 10.

    Donsbeck AV, Ranchere D, Coindre JM, Le Gall F, Cordier JF, Loire R. Primary cardiac sarcomas: an immunohistochemical and grading study with long-term follow-up of 24 cases. Histopathology. 1999;34:295–304.

  11. 11.

    Hoffmann U, Globits S, Schima W, et al. Usefulness of magnetic resonance imaging of cardiac and paracardiac masses. Am J Cardiol. 2003.

  12. 12.

    Beroukhim RS, Prakash A, Valsangiacomo Buechel ER, et al. Characterization of cardiac tumors in children by cardiovascular magnetic resonance imaging: a multicenter experience. J Am Coll Cardiol. 2011.

  13. 13.

    Mousavi N, Cheezum MK, Aghayev A, et al. Assessment of cardiac masses by cardiac magnetic resonance imaging: histological correlation and clinical outcomes. J Am Heart Assoc. 2019.

  14. 14.

    Pazos-López P, Pozo E, Siqueira ME, et al. Value of CMR for the differential diagnosis of cardiac masses. JACC Cardiovascular Imaging. 2014.

  15. 15.

    Thomsen HS, Morcos SK, Almén T, et al. Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR contrast medium safety committee guidelines. Eur Radiol. 2013.

  16. 16.

    Kanal E, Barkovich AJ, Bell C, et al. ACR guidance document on MR safe practices. J Magn Reson Imaging. 2013:2013.

  17. 17.

    Levine GN, Gomes AS, Arai AE, et al. Safety of magnetic resonance imaging in patients with cardiovascular devices: an American heart association scientific statement from the committee on diagnostic and interventional cardiac catheterization, council on clinical cardiology, and the council o. Circulation. 2007.

  18. 18.

    Symons R, Nazarian S, Halperin H, Bluemke D. Safety and monitoring for cardiac magnetic resonance imaging. In: Safety and monitoring for cardiac magnetic resonance imaging. 2nd ed; 2019.

  19. 19.

    Anon. American College of Radiology (ACR) Website. ACR manual on contrast media, version 10.1. https://www.acr.org/Clinical-Resources/Contrast-Manual.

  20. 20.

    Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E. Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson. 2008.

  21. 21.

    Russo RJ, Costa HS, Silva PD, et al. Assessing the risks associated with MRI in patients with a pacemaker or defibrillator. N Engl J Med. 2017.

  22. 22.

    Kalin R, Stanton MS. Current clinical issues for MRI scanning of pacemaker and defibrillator patients. Pacing Clin Electrophysiol. 2005.

  23. 23.

    Parwani P, Lopez-Mattei J, Choi A. Building bridges in cardiology and radiology why collaboration is the future of cardiovascular imaging. J Am Coll Cardiol. 2018;72:2534–8.

  24. 24.

    Simonetti OP, Finn JP, White RD, Laub G, Henry DA. “Black blood” T2-weighted inversion-recovery MR imaging of the heart. Radiology. 2014.

  25. 25.

    Stehling MK, Holzknecht NG, Laub G, Böhm D, Von Smekal A, Reiser M. Single-shot T1- and T2-weighted magnetic resonance imaging of the heart with black blood: preliminary experience. Magn Reson Mater Phys Biol Med. 1996.

  26. 26.

    Jeong D, Patel A, Francois CJ, Gage KL, Fradley MG. Cardiac magnetic resonance imaging in oncology. Cancer Control. 2017;24:147–60.

  27. 27.

    Kim MJ, Song JK, Song JM, et al. Long-term outcomes of significant mitral regurgitation after percutaneous mitral valvuloplasty. Circulation. 2006.

  28. 28.

    Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR. Cardiac myxoma: imaging features in 83 patients. RadioGraphics. 2002.

  29. 29.

    Schvartzman PR, White RD. Imaging of cardiac and paracardiac masses. J Thorac Imaging. 2000.

  30. 30.

    Singh SD, Lansing AM. Familial cardiac myxoma--a comprehensive review of reported cases. J Kentucky Med Assoc. 1996;94:96–104 Available at: http://www.ncbi.nlm.nih.gov/pubmed/8820573.

  31. 31.

    Sparrow P, Kurian J, Jones T, Sivananthan M. MR imaging of cardiac tumors. RadioGraphics. 2005;25:1255–76.

  32. 32.

    Masui T, Takahashi M, Miura K, Naito M, Tawarahara K. Cardiac myxoma: identification of intratumoral hemorrhage and calcification on MR images. Am J Roentgenol. 1995;164:850–2.

  33. 33.

    Yusuf SW, Daraban N, Abbasi N, Lei X, Durand JB, Daher IN. Treatment and outcomes of acute coronary syndrome in the cancer population. Clin Cardiol. 2012.

  34. 34.

    Abbas A, Garfath-Cox KAG, Brown IW, Shambrook JS, Peebles CR, Harden SP. Cardiac MR assessment of cardiac myxomas. Br J Radiol. 2015;88:3–7.

  35. 35.

    Basso C, Valente M, Poletti A, Casarotto D, Thiene G. Surgical pathology of primary cardiac and pericardial tumors. Eur J Cardiothorac Surg. 1997.

  36. 36.

    Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR. Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation. RadioGraphics. 2013.

  37. 37.

    Araoz P, Mulvagh S, Tazelaar H, Julsrud P, Breen J. CT and MR imaging of benign primary cardiac neoplasms with echocardiographic correlation. RadioGraphics. 2000;20:1303–19.

  38. 38.

    Rahsepar AA, Ghasemiesfe A, Sawlani RN, et al. A papillary fibroelastoma involving aortic and pulmonary valves: findings on multimodality imaging. Ann Thorac Surg. 2017.

  39. 39.

    Palaskas N, Thompson K, Gladish G, et al. Evaluation and management of cardiac tumors. Curr Treat Options Cardiovasc Med. 2018;20.

  40. 40.

    Capotosto L, Elena G, Massoni F, de Sio S, Carnevale A, Ricci S, et al. Cardiac tumors: echocardiographic diagnosis and forensic correlations. Am J Forensic Med Pathol. 2016;37:306–16.

  41. 41.

    D’Souza J, Shah R, Abbass A, Burt JR, Goud A, Dahagam C. Invasive cardiac lipoma: a case report and review of literature. BMC Cardiovascular Disorders. 2017.

  42. 42.

    Castillo JG, Silvay G. Characterization and management of cardiac tumors. Semin Cardiothorac Vasc Anesth. 2010.

  43. 43.

    Esposito A, De Cobelli F, Ironi G, et al. CMR in the assessment of cardiac masses: primary malignant tumors. JACC Cardiovascular Imaging. 2014.

  44. 44.

    Al Jabbari O, Abu Saleh W, Patel A, Igo S, Reardon M. Use of three-dimentional models to assist in the resection of mlignant tumors. J Card Surg. 2016;31:581–3.

  45. 45.

    Sokullo O, Sanioglu S, Deniz H, Ayoglu U, Ozgen A, Bilgen F. Primary cardiac rhabdomyosarcoma of the right atrium: case report. Heart Surg Forum. 2008;11:E117–9.

  46. 46.

    Clarke NRA, Mohiaddin RH, Westaby S, Banning AP. Multifocal cardiac leiomyosarcoma. Diagnosis and surveillance by transoesophageal echocardiography and contrast enhanced cardiovascular magnetic resonance. Postgrad Med J. 2002.

  47. 47.

    Lichtenberger JP, Dulberger AR, Gonzales PE, Bueno J, Carter BW. MR imaging of cardiac masses. Top Magn Reson Imaging. 2018.

  48. 48.

    Hudzik B, Miszalski-Jamka K, Glowacki J, Lekston A, Gierlotka M, Zembala M, et al. Malignant tumors of the heart. Cancer Epidemiol. 2015;39:665–72.

  49. 49.

    Hoey ETD, Shahid M, Ganeshan A, Baijal S, Simpson H, Watkin RW. MRI assessment of cardiac tumours: part 2, spectrum of appearances of histologically malignant lesions and tumour mimics. Quant Imaging Med Surg. 2014.

  50. 50.

    Restrepo CS, Largoza A, Lemos DF, et al. CT and MR imaging findings of malignant cardiac tumors. Curr Probl Diagn Radiol. 2005.

  51. 51.

    Vaidya O, Dobson J, Wible B, Main M. Usefulness of multimodality cardiac imaging in the diagnosis of a right atrial angiosarcoma. J Am Soc Echocardiogr. 2010;23:792.

  52. 52.

    Wong C, El-Jack S, Edwards C, Patel H. Primary cardiac angiosarcoma: morphologically deceptive benign appearance and potential pitfalls in diagnosis. Heart Lung Circ. 2010;19:473–5.

  53. 53.

    Jaksic Jurinjak S, Vincelj J, Rudez I, et al. Primary left atrial angiosarcoma presenting as acute coronary syndrome. Heart Surg Forum. 2019.

  54. 54.

    Araoz PA, Eklund HE, Welch TJ, Breen JF. CT and MR imaging of primary cardiac malignancies. RadioGraphics. 2013.

  55. 55.

    Díaz Angulo C, Méndez Díaz C, Rodríguez García E, Soler Fernández R, Rois Siso A, Marini DM. Hallazgos de imagen de las masas cardíacas (parte II): tumores malignos y lesiones pseudotumorales. Radiologia. 2016.

  56. 56.

    Vander Salm TJ. Unusual primary tumors of the heart. Semin Thorac Cardiovasc Surg. 2000.

  57. 57.

    Neragi-Miandoab S, Kim J, Vlahakes GJ. Malignant tumours of the heart: a review of tumour type, diagnosis and therapy. Clin Oncol. 2007.

  58. 58.

    Tüdös Z, Köcher M, Černá M, et al. “Sun Ray” appearance in a case of cardiac angiosarcoma: a comparison of MRI and PET/CT. Magn Reson Med Sci. 2016.

  59. 59.

    Linder J, Woodard B. Primary cardiac fibrosarcoma. South Med J. 1985;78:607–8.

  60. 60.

    Anand A, Anand N, Anand A. Primary cardiac fibrosarcoma. Am Heart J. 1996;132:1320–1.

  61. 61.

    Gilkeson RC, Chiles C. MR evaluation of cardiac and pericardial malignancy. Magn Reson Imaging Clin N Am. 2003.

  62. 62.

    Suehiro S, Matsada M, Hirata T, et al. Primary cardiac rhabdomyosarcoma developed after receiving radiotherapy for left breast cancer 18 years prior. J Cardiol Cases. 2017;15:181–3.

  63. 63.

    Randhawa K, Ganeshan A, Hoey ETD. Magnetic resonance imaging of cardiac tumors: part 2, malignant tumors and tumor-like conditions. Curr Probl Diagn Radiol. 2011;40:169–79.

  64. 64.

    Zanobini M, Travaglini S, Pepi M, Saccocci M. Primary tumor or metastasis? Extremely rare fibrosarcoma of the left atrial appendage. J Thorac Cardiovasc Surg. 2018.

  65. 65.

    Balaney B, Mitzman B, Fung J, Paul JD. Diagnosis and management of rare inferior vena cava leiomyosarcoma guided by a novel minimally invasive vascular biopsy technique. Catheter Cardiovasc Interv. 2018.

  66. 66.

    Nijjar PS, Masri SC, Tamene A, Kassahun H, Liao K, Valeti U. Benefits and limitations of multimodality imaging in the diagnosis of a primary cardiac lymphoma. Tex Heart Inst J. 2014.

  67. 67.

    Utsunomiya D, Awai K, Urata J, Hirayama T, Yamashita Y. Primary cardiac lymphoma: computed tomography and magnetic resonance imaging features. Jpn J Radiol. 2009.

  68. 68.

    Li Y, Zhou Z, Xin F, et al. Primary cardiac lymphoma in both atria: a case report. J Clin Ultrasound. 2019.

  69. 69.

    Hu S, Zhu L, Ke J, Sun Y, Hu C. Imaging features of primary cardiac lymphoma. Chin Med J (Eng). 2017;130:2123–5.

  70. 70.

    Wang S, Li M, Zhang L, Xie M. Multimodal imaging evaluation of a primary cardiac lymphoma in an immunocompetent patient. Echocardiography. 2018.

  71. 71.

    Coulier B, Colin GC, Tourmous H, Floris N, Van Eeckhout P, Scavée C. Imaging features of primary cardiac lymphoma. Diagn Interv Imaging. 2018.

  72. 72.

    Taguchi S. Comprehensive review of the epidemiology and treatments for malignant adult cardiac tumors. Gen Thorac Cardiovasc Surg. 2018;66:257–62.

  73. 73.

    Pun SC, Plodkowski A, Matasar MJ, et al. Pattern and prognostic implications of cardiac metastases among patients with advanced systemic cancer assessed with cardiac magnetic resonance imaging. J Am Heart Assoc. 2016.

  74. 74.

    Paydarfar D, Krieger D, Dib N, et al. In vivo magnetic resonance imaging and surgical histopathology of intracardiac masses: distinct features of subacute thrombi. Cardiology. 2001.

  75. 75.

    Barkhausen J, Hunold P, Eggebrecht H, et al. Detection and characterization of intracardiac thrombi on MR imaging. Am J Roentgenol. 2002.

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Correspondence to Juan Lopez-Mattei.

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Parwani, P., Co, M., Ramesh, T. et al. Differentiation of Cardiac Masses by Cardiac Magnetic Resonance Imaging. Curr Cardiovasc Imaging Rep 13, 1 (2020) doi:10.1007/s12410-019-9522-4

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Keywords

  • Cardiac MRI
  • Cardiac mass
  • Cardiac tumor