Cardiac Tumors and Pseudotumors

Abstract

Cardiac magnetic resonance (CMR) is considered the gold standard for non-invasive characterization of cardiac masses and pseudomasses. CMR allows to evaluate the signal properties, morphological characteristics (location, size, infiltrative nature, presence of pleural/pericardial effusions), and vascularization (first-pass perfusion, early and late enhancement) of cardiac masses. CMR is able to differentiate between tumors and pseudotumors (such as Chiari networks, other embryological remnants, pericardial or bronchogenic cysts, calcific necrosis of mitral annulus, giant aneurysm of coronary arteries, and intracavitary thrombi). Moreover, it allows to assess the likelihood of malignancy of cardiac tumors and finally to follow-up the mass over time and/or after therapy. The main advantage of CMR is the capability of tissue characterization acting as “virtual histology.” Tissue characterization is generally performed using conventional pre- and post-contrast sequences as well as multiparametric imaging. CMR allows identification of the nature of the tumor with great accuracy in case of benign lesions as myxomas, fibromas, and lipomas. In evaluating tumors, the term “malignancy” is generally used for its oncological meaning. On the other hand, other tumors, even though considered histologically benign, may have a “malignant” location because they obstruct cardiac chambers, impair valvular and cardiac function, and cause heart failure and/or arrhythmias.

Following an introductory chapter elucidating an up-to-date perspective on the multiple potentials of CMR imaging in patients with cardiac masses and pseudomasses, ten clinical cases are shown to highlight the full potential of CMR imaging.