Author + information
- Received April 1, 2014
- Revision received May 12, 2014
- Accepted May 13, 2014
- Published online September 1, 2014.
- Pablo Pazos-López, MD∗,†,
- Eduardo Pozo, MD∗,
- Maria E. Siqueira, MD∗,
- Inés García-Lunar, MD∗,†,
- Matthew Cham, MD∗,
- Adam Jacobi, MD∗,
- Frank Macaluso, BS∗,
- Valentín Fuster, MD, PhD∗,†,
- Jagat Narula, MD, PhD∗ and
- Javier Sanz, MD∗∗ ()
- ∗The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Hospital, New York, New York
- †Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- ↵∗Reprint requests and correspondence:
Dr. Javier Sanz, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Objectives The goal of this study was to evaluate the diagnostic value of CMR features for the differential diagnosis of cardiac masses.
Background Differentiation of cardiac tumors and thrombi and differentiation of benign from malignant cardiac neoplasms is often challenging but important in clinical practice. Studies assessing the value of cardiac magnetic resonance (CMR) in this regard are scarce.
Methods We reviewed the CMR scans of patients with a definite cardiac thrombus or tumor. Mass characteristics on cine, T1-weighted turbo spin echo (T1w-TSE) and T2-weighted turbo spin echo (T2w-TSE), contrast first-pass perfusion (FPP), post-contrast inversion time (TI) scout, and late gadolinium enhancement (LGE) sequences were analyzed.
Results There were 84 thrombi, 17 benign tumors, and 25 malignant tumors in 116 patients. Morphologically, thrombi were smaller (median area 1.6 vs. 8.5 cm2; p < 0.0001), more homogeneous (99% vs. 46%; p < 0.0001), and less mobile (13% vs. 33%; p = 0.007) than tumors. Hyperintensity compared with normal myocardium on T2w-TSE, FPP, and LGE were more common in tumors than in thrombi (85% vs. 42%, 70% vs. 4%, and 71% vs. 5%, respectively; all p < 0.0001). A pattern of hyperintensity/isointensity (compared with normal myocardium) with short TI and hypointensity with long TI was very frequent in thrombi (94%), rare in tumors (2%), and had the highest accuracy (95%) for the differentiation of both entities. Regarding the characterization of neoplastic masses, malignant tumors were larger (median area 11.9 vs. 6.3 cm2; p = 0.006) and more frequently exhibited FPP (84% vs. 47%; p = 0.03) and LGE (92% vs. 41%; p = 0.001). The ability of CMR features to distinguish benign from malignant neoplasms was moderate, with LGE showing the highest accuracy (79%).
Conclusions CMR features demonstrated excellent accuracy for the differentiation of cardiac thrombi from tumors and can be helpful for the distinction of benign versus malignant neoplasms.
- benign cardiac tumor
- cardiac magnetic resonance
- cardiac mass
- cardiac thrombus
- cardiac tumor
- malignant cardiac tumor
Dr. Narula has received research support in the form of an equipment grant to the institution from Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr. Nathaniel Reichek has served as Guest Editor for this paper.
- Received April 1, 2014.
- Revision received May 12, 2014.
- Accepted May 13, 2014.
- American College of Cardiology Foundation