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Evaluation and Management of Cardiac Tumors

Current Treatment Options in Cardiovascular Medicine volume 20, Article number: 29 (2018) Cite this article

Abstract

Purpose of review

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.

Recent findings

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.

Summary

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.

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Affiliations

  1. Department of Cardiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1451, Houston, TX, 77030, USA

    Nicolas Palaskas MD, Kara Thompson MD, Saamir Hassan MD, Cezar Iliescu MD, Peter Kim MD, Jean B. Durand MD & Juan C. Lopez-Mattei MD

  2. Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Gregory Gladish MD & Juan C. Lopez-Mattei MD

  3. Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA

    Ali M. Agha MD

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  1. Nicolas Palaskas MD
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  2. Kara Thompson MD
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  3. Gregory Gladish MD
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  4. Ali M. Agha MD
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  5. Saamir Hassan MD
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  6. Cezar Iliescu MD
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  7. Peter Kim MD
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  8. Jean B. Durand MD
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  9. Juan C. Lopez-Mattei MD
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Correspondence to Juan C. Lopez-Mattei MD.

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Conflict of Interest

Nicolas Palaskas, Kara Thompson, Ali M. Agha, Saamir Hassan, Cezar Iliescu, Peter Kim, Jean B. Durand, and Juan C. Lopez-Mattei each declare no potential conflicts of interest. Gregory Gladish reports speaker honoraria from Bristol Myers Squibb.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Cardio-oncology

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Palaskas, N., Thompson, K., Gladish, G. et al. Evaluation and Management of Cardiac Tumors. Curr Treat Options Cardio Med 20, 29 (2018). https://doi.org/10.1007/s11936-018-0625-z

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Keywords

  • Cardio-oncology
  • Cardiac tumors
  • Cardiac MRI
  • CMR
  • Tissue characterization
  • Primary cardiac tumors
  • Secondary cardiac tumors
  • Echocardiography
  • Late gadolinium enhancement
  • Papillary fibroelastoma
  • Lymphoma
  • Sarcoma
  • Cardiac autotransplantation