Author + information
- Received December 5, 2019
- Revision received March 2, 2020
- Accepted March 16, 2020
- Published online June 17, 2020.
- Emanuela Concetta D’Angelo, MDa,∗,
- Pasquale Paolisso, MDa,∗,
- Giovanni Vitale, MDa,
- Alberto Foà, MDa,
- Luca Bergamaschi, MDa,
- Ilenia Magnani, MDa,
- Giulia Saturi, MDa,
- Andrea Rinaldi, MDa,
- Sebastiano Toniolo, MDa,
- Matteo Renzulli, MDb,
- Domenico Attinà, MDc,
- Luigi Lovato, MDc,
- Giacomo Maria Lima, MDd,
- Rachele Bonfiglioli, MDd,
- Stefano Fanti, MD, PhDd,
- Ornella Leone, MDe,
- Maristella Saponara, MDf,
- Maria Abbondanza Pantaleo, MDf,
- Paola Rucci, PhDg,
- Luca Di Marco, MDh,
- Davide Pacini, MD, PhDh,
- Carmine Pizzi, MDa,∗,† ( and )
- Nazareno Galiè, MD, PhDa,†
- aDepartment of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- bRadiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
- cRadiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
- dInstitute of Nuclear Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- eDepartment of Pathology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi of Bologna, Italy
- fDepartment of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- gDivision of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- hCardiac Surgery Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- ↵∗Address for correspondence:
Dr. Carmine Pizzi, Department of Experimental, Diagnostic and Specialty Medicine—DIMES (Padiglione 23), University of Bologna, Via Giuseppe Massarenti 9, Bologna 40138, Italy.
Objectives This study sought to assess the diagnostic accuracy of cardiac computed tomography (CT) and 18F-fluorodeoxyglucose (18F-FDG) with positron emission tomography/computed tomography (PET/CT) in defining the nature of cardiac masses.
Background The diagnostic accuracy of cardiac CT and 18F-FDG PET/CT in identifying the nature of cardiac masses has been analyzed to date only in small samples.
Methods Of 223 patients with echocardiographically diagnosed cardiac masses, a cohort of 60 cases who underwent cardiac CT and 18F-FDG PET/CT was selected. All masses had histological confirmation, except for a minority of thrombotic formations. For each mass, 8 morphological CT signs, standardized uptake value (SUVmax, SUVmean), metabolic tumor volume, and total lesion glycolysis in 18F-FDG PET were used as diagnostic markers.
Results Irregular tumor margins, pericardial effusion, invasion, solid nature, mass diameter, CT contrast uptake, and pre-contrast characteristics were strongly associated with the malignant nature of masses. The coexistence of at least 5 CT signs perfectly identified malignant masses, whereas the detection of 3 or 4 CT signs did not accurately discriminate the masses’ nature. The mean SUVmax, SUVmean, metabolic tumor volume, and total lesion glycolysis values were significantly higher in malignant than in benign masses. The diagnostic accuracy of SUV, metabolic tumor volume, and total lesion glycolysis 18F-FDG PET/CT parameters was excellent in detecting malignant masses. Among patients with 3 or 4 pathological CT signs, the presence of at least 1 abnormal 18F-FDG PET/CT parameter significantly increased the identification of malignancies.
Conclusions Cardiac CT is a powerful tool to diagnose cardiac masses as the number of abnormal signs was found to correlate with the lesions’ nature. Similarly, 18F-FDG PET/CT accurately identified malignant masses and contributed with additional valuable information in diagnostic uncertainties after cardiac CT. These imaging tools should be performed in specific clinical settings such as involvement of great vessels or for disease-staging purposes.
- cardiac computed tomography
- 18F-fluorodeoxyglucose with positron emission tomography/computed tomography
- primary cardiac benign tumors
- primary malignant tumors
- secondary malignant tumors
↵∗ Drs. D’Angelo and Paolisso contributed equally to this work.
↵† Dr. Pizzi and Galié contributed equally to this work.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received December 5, 2019.
- Revision received March 2, 2020.
- Accepted March 16, 2020.
- 2020 American College of Cardiology Foundation
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