Author + information
- Antonio Esposito, MD∗ (, )
- Francesco De Cobelli, MD,
- Gabriele Ironi, MD,
- Paolo Marra, MD,
- Tamara Canu, RT,
- Renata Mellone, MD and
- Alessandro Del Maschio, MD
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- ↵∗Reprint requests and correspondence:
Dr. Antonio Esposito, Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
CARDIAC MAGNETIC RESONANCE (CMR) PLAYS AN IMPORTANT ROLE IN THE ASSESSMENT OF CARDIAC tumors, because it combines high contrast and spatial resolution with a panoramic view of the heart and surrounding structures and an unmatched ability to characterize tissues. So, CMR assessment is frequently recommended to patients with cardiac masses to confirm the lesion, orient the diagnosis toward the benign or malignant nature, and guide the subsequent patient management.
Following the Imaging Vignette about benign primary cardiac tumors (1), here is presented a selection of images to underline the peculiar CMR features of the most frequent primary cardiac malignancies (Figures 1 to 3⇓⇓) and pseudo-masses (Figure 4).
Concerning the topography, morphology, and signal intensity, the features suggesting malignant nature are: invasion of extracardiac structures, involvement of >1 cardiac chamber, involvement of the right side of the heart, tissue inhomogeneity, poor definition of borders, >5 cm diameter, and presence of pericardial or pleural effusion.
To confirm the diagnosis of malignancy and to better characterize its nature, the acquisition of a perfusion study during contrast agent injection is recommended (Figures 1 and 3). Qualitative assessment of enhancement may help in the mass characterization, and moreover, semiquantitative analysis of enhancement curves provides additional criteria for the evaluation of tumor aggressiveness and for identification of cardiac malignancy (2).
On the other side, when thrombotic lesions are suspected, the acquisition of late gadolinium enhancement images with the specific choice of long inversion times (such as 600 ms), matching the null point of “avascular tissue,” leads to a homogeneous hypointense appearance of thrombi clearly distinguishable from the surrounding myocardium (3) (Figure 4).
To help with the differential diagnosis of malignancies from benign tumors and pseudo-masses and to provide some skills for a further cardiac mass characterization, we composed a table that sums up the main imaging features of the masses most commonly found in the heart (Table 1).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
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