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Cheaban R, Piran M, Opacic D, Gummert JF, Rojas SV. Epicardial cavernous haemangioma; A case report of a unique incidental finding. Eur Heart J Case Rep 2024; 8:ytae146. [PMID: 38660462 PMCID: PMC11042575 DOI: 10.1093/ehjcr/ytae146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024]
Abstract
Background Primary cardiac tumours are rare, accounting for only 0.002-0.03% at autopsy. Cardiac haemangiomas are benign vascular tumours and constitute for 0.28% of all primary cardiac tumours. Cavernous haemangiomas, capillary haemangiomas, and arteriovenous haemangiomas are three distinct types. Cardiac haemangiomas are often misdiagnosed as myxomas and must be differentiated from malignant angiosarcomas. Case summary We present a 44-year-old Mediterranean male patient with a cavernous haemangioma in the inferior vena cava and right atrium, detected on transthoracic echocardiography. The patient experienced palpitations and dyspnoea on exertion. Computed tomography (CT) angiography revealed a 7.5 × 6 × 5 cm mass suspected to be perfused by the distal right coronary artery. A watch-and-wait approach was suggested, leading to a cardiac magnetic resonance imaging (MRI) with contrast 6 months later. T1 mapping exhibited a prolonged relaxation time and isointensity to the myocardium. T2 mapping revealed a homogenous hyperintense mass with heterogenous late enhancement. Surgical excision was performed using a bicaval cannulation technique on cardiopulmonary bypass. Intraoperatively, no connection to the coronaries was noted. At 1 year follow-up, the patient reported restored physical resilience, with no evidence of tumour recurrence. Discussion Clinical symptoms of cardiac cavernous haemangiomas are unspecific and become evident once the tumour grows. To investigate the nature and vascular involvement of the tumour, a contrast-enhanced CT angiography or MRI can be performed. Cardiac haemangiomas are often misdiagnosed and must be differentiated from malignant angiosarcomas. Clear guidelines for the treatment of cardiac haemangiomas in adult patients are lacking. Primary cardiac tumours require thorough investigation, and surgical intervention should be tailored to the individual's case.
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Affiliation(s)
- Rayan Cheaban
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Med. Fakultät OWL (Universität Bielefeld), Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Misagh Piran
- Clinic for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, University Hospital, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Dragan Opacic
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Med. Fakultät OWL (Universität Bielefeld), Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Med. Fakultät OWL (Universität Bielefeld), Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Med. Fakultät OWL (Universität Bielefeld), Georgstraße 11, 32545 Bad Oeynhausen, Germany
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Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 69] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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Aggeli C, Dimitroglou Y, Raftopoulos L, Sarri G, Mavrogeni S, Wong J, Tsiamis E, Tsioufis C. Cardiac Masses: The Role of Cardiovascular Imaging in the Differential Diagnosis. Diagnostics (Basel) 2020; 10:diagnostics10121088. [PMID: 33327646 PMCID: PMC7765127 DOI: 10.3390/diagnostics10121088] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiac masses are space occupying lesions within the cardiac cavities or adjacent to the pericardium. They include frequently diagnosed clinical entities such as clots and vegetations, common benign tumors such as myxomas and papillary fibroelastomas and uncommon benign or malignant primary or metastatic tumors. Given their diversity, there are no guidelines or consensus statements regarding the best diagnostic or therapeutic approach. In the past, diagnosis used to be made by the histological specimens after surgery or during the post-mortem examination. Nevertheless, evolution and increased availability of cardiovascular imaging modalities has enabled better characterization of the masses and the surrounding tissue. Transthoracic echocardiography using contrast agents can evaluate the location, the morphology and the perfusion of the mass as well as its hemodynamic effect. Transesophageal echocardiography has increased spatial and temporal resolution; hence it is superior in depicting small highly mobile masses. Cardiac magnetic resonance and cardiac computed tomography are complementary providing tissue characterization. The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account the epidemiology and clinical presentation of the cardiac masses, as well as the availability and the incremental value of each imaging modality.
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Affiliation(s)
- Constantina Aggeli
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
- Correspondence:
| | - Yannis Dimitroglou
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Leonidas Raftopoulos
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Georgia Sarri
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Sophie Mavrogeni
- Department of Cardiology, Onassis Cardiac Surgery Centre, 17674 Kallithea, Attica, Greece;
| | - Joyce Wong
- Department of Cardiology, Harefield Hospital and Royal Brompton Hospital, London UB96JH, UK;
| | - Eleftherios Tsiamis
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Costas Tsioufis
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
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Rahouma M, Arisha MJ, Elmously A, El-Sayed Ahmed MM, Spadaccio C, Mehta K, Baudo M, Kamel M, Mansor E, Ruan Y, Morsi M, Shmushkevich S, Eldessouki I, Rahouma M, Mohamed A, Gambardella I, Girardi L, Gaudino M. Cardiac tumors prevalence and mortality: A systematic review and meta-analysis. Int J Surg 2020; 76:178-189. [PMID: 32169566 DOI: 10.1016/j.ijsu.2020.02.039] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Cardiac tumors and their associated outcomes are poorly characterized. This study sought to comprehensively assess the epidemiology and natural history of primary and secondary malignant cardiac tumors (PMCT and SMCT), a well as establish predictors of mortality. METHODS A comprehensive literature review was performed to identify articles reporting on PMCTs and SMCTs. The prevalence of important cardiac tumor (CT) subtypes was evaluated and further stratified based on the continental region. Outcomes of interest included short- and long-term mortality and utilization of heart transplantation (HTX). A random effect model was adopted, and a meta-regression was performed to determine predictors of the prevalence of CTs as well as predictors of operative mortality. RESULTS Of the 1,226 retrieved articles, 74 were included in our study (n = 8,849 patients). The mean follow-up was 2.27 years, mean age was 42.9 years, and 55% of the patients were females. There was a total number of 7,484 benign primary cardiac tumors (PCTs) (5,140 were myxoma), 862 (9.7%) malignant PCTs, and 355 secondary cardiac tumors. The prevalence of PMCTs among PCTs was 10.83% [95%CI = 09.11; 12.83%] with a trend towards being lower in South America compared to other continents (Prevalence = 5.80%). The prevalence of HTX among all patients was 2.45% [1.36; 4.38%]. The pooled short-term mortality was 5.90% [4.70; 7.39%] and the incidence of late mortality in all CTs, benign CT and PMCTs was 2.55% [1.76; 3.72%], 0.79% [0.46; 1.37%] and 14.77% [9.32; 23.40%], respectively. On meta-regression, the annual volume of cardiac tumor cases per center was the only predictor of lower early mortality (Beta = -0.14 ± 0.03, P < 0.0001). CONCLUSIONS PMCTs represent the minority of PCT (~10%) and have a higher prevalence in Europe and North America. Survival is higher in benign pathology and is significantly improved by treatment in specialized high-volume centers. Approximately 2% of patients with CTs undergo heart transplantation.
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Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA; Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt.
| | - Mohammed J Arisha
- Internal Medicine Department, West Virginia University Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Adham Elmously
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | | | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, Glasgow, G814DY, UK; Institute of Cardiovascular and Medical Sciences, Veterinary and Life Sciences, College of Medical, University of Glasgow, Glasgow, G128QQ, UK
| | - Kritika Mehta
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Massimo Baudo
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mohamed Kamel
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA; Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Esraa Mansor
- Internal Medicine Department, West Virginia University Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Yongle Ruan
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mahmoud Morsi
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Shon Shmushkevich
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Ihab Eldessouki
- Medical Oncology Department, University of Cincinnati Cancer Institute, Cincinnati, OH, USA
| | - Mostafa Rahouma
- Information Technology Department, National Cancer Institute, Cairo University, Egypt
| | - Abdelrahamn Mohamed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Ivancarmine Gambardella
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Leonard Girardi
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mario Gaudino
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
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Guan T, Li Y, Qiu Z, Zhang Y, Lin W, Lai Y, Wang K, Shen Y, Du L, Liu C. Nomograms and risk classification systems predicting overall and cancer-specific survival in primary malignant cardiac tumor. J Card Surg 2019; 34:1540-1549. [PMID: 31794125 DOI: 10.1111/jocs.14299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary malignant cardiac tumors (PMCTs) are fatal, but up to now, there is still a lack of survival prediction model for prognosis evaluation. We developed nomograms to predict overall survival (OS) and cancer-specific survival (CSS) for PMCTs by the Surveillance, Epidemiology, and End Result (SEER) database. METHODS A total of 506 PMCTs participants were identified in the SEER database from 1973 to 2014 and were randomly assigned into the training cohort (N = 354) and the validation cohort (N = 152). The prognostic factors for PMCTs were identified by Kaplan-Meier and multivariate Cox analysis and further incorporated to build OS and CSS nomograms. The nomograms were internally and externally validated via concordance indexes (C-index) and calibration curves. RESULTS The independent prognostic factors for OS and CSS in PMCTs were associated with age at diagnosis, histopathology, tumor stage, cancer-directed surgery, and chemotherapy (all P < .05). In the internal validation, the C-index values were 0.71 (95% confidence interval [CI]: 0.68-0.75) for OS nomogram, and 0.70 (95% CI: 0.67-0.74) for CSS nomogram. In the external validation, the C-index values were 0.71 (95% CI: 0.66-0.77) for OS nomogram, and 0.71 (95% CI: 0.65-0.77) for CSS nomogram. The calibration curves of internal and external validation showed consistency between the nomograms and the actual observation. The risk stratification of PMCTs was significant distinction (P < .05). CONCLUSION We developed and validated credible nomograms to predict OS and CSS in PMCTs. These nomograms can be offered to clinicians to more precisely estimate the survival and identify risk stratification of PMCTs.
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Affiliation(s)
- Tianwang Guan
- Department of Cardiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yanfang Li
- Department of Cardiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zicong Qiu
- Department of Clinical Medicine, Clinical Medical College, Guangzhou Medical University, Guangzhou, China
| | - Yichi Zhang
- Department of Clinical Medicine, Clinical Medical College, Guangzhou Medical University, Guangzhou, China
| | - Wenrui Lin
- Department of Clinical Medicine, Clinical Medical College, Guangzhou Medical University, Guangzhou, China
| | - Yanxian Lai
- Department of Cardiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Kenie Wang
- Department of Clinical Medicine, Clinical Medical College, Guangzhou Medical University, Guangzhou, China
| | - Yan Shen
- Department of Cardiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Liping Du
- Department of Cardiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Cheng Liu
- Department of Cardiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China.,Department of Cardiology, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
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Meurgey A, Henaine R, Bouvagnet P, Chalabreysse L. [About a case of a recurrent glandular cardiac myxoma in a child]. Ann Pathol 2016; 36:214-7. [PMID: 27234518 DOI: 10.1016/j.annpat.2016.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/21/2015] [Accepted: 01/31/2016] [Indexed: 10/21/2022]
Abstract
Primary cardiac tumors are extremely rare and mainly benign. The majority of these are myxomas (40%). Myxoma are generally sporadic tumors which occur most commonly in adult females between 30 and 40 years, and are seldom found in the paediatric population (5%). Seven percent are associated with igenetic diseases. We report the case of an eight-year-old boy presenting a recurrent glandular cardiac myxoma. In 2011, he presented a deterioration of the general state. An echocardiography highlighted a left atrial mass on the interatrial septum, with a pedicular insertion. On the microscope, it consisted of a proliferation of stellate cells isolated or clustered in rudimentary vessels in a myxoid stroma presenting haemorrhage changes. These cells expressed CD34 and calretinine. Glandular elements without atypia were clustered within the myxomatous proliferation. They expressed cytokeratin (CK) 7. Surgical resection was macroscopically complete. In 2014, the boy had a sudden neurological deficit during a football match. An echocardiography revealed a recurrence at the same location. The lesion was excised and addressed in several fragments. Classical myxoma was associated with glands without atypia. This last component expressed CKAE1/AE3 and CK7. Ki67 index of proliferation was low. The surgical reintervention was macroscopically complete. The final diagnosis was glandular cardiac myxoma. A genetic survey was conducted, showing the presence of Carney complex. This is the first description in the litterature of a recurrent glandular cardiac myxoma occuring in a child.
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Affiliation(s)
- Alexandra Meurgey
- Service d'anatomie et cytologie pathologique, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France
| | - Roland Henaine
- Unité médico-chirurgicale des cardiopathies congénitales adultes et enfants, groupement hospitalier Est, hospices civils de Lyon, 69677 Lyon, France
| | - Patrice Bouvagnet
- EA 4173, laboratoire cardiogénétique, groupement hospitalier Est, hospices civils de Lyon, université Lyon 1 et hôpital Nord Ouest, 69677 Lyon, France
| | - Lara Chalabreysse
- Service d'anatomie et cytologie pathologique, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France.
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Chalian H, O'Donnell JK, Bolen M, Rajiah P. Incremental value of PET and MRI in the evaluation of cardiovascular abnormalities. Insights Imaging 2016; 7:485-503. [PMID: 27221975 PMCID: PMC4956622 DOI: 10.1007/s13244-016-0494-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/01/2016] [Accepted: 04/22/2016] [Indexed: 12/11/2022] Open
Abstract
Abstract The cardiovascular system is affected by a wide range of pathological processes, including neoplastic, inflammatory, ischemic, and congenital aetiology. Magnetic resonance imaging (MRI) and positron emission tomography (PET) are state-of-the-art imaging modalities used in the evaluation of these cardiovascular disorders. MRI has good spatial and temporal resolutions, tissue characterization and multi-planar imaging/reconstruction capabilities, which makes it useful in the evaluation of cardiac morphology, ventricular and valvar function, disease characterization, and evaluation of myocardial viability. FDG-PET provides valuable information on the metabolic activity of the cardiovascular diseases, including ischemia, inflammation, and neoplasm. MRI and FDG-PET can provide complementary information on the evaluation of several cardiovascular disorders. For example, in cardiac masses, FDG-PET provides the metabolic information for indeterminate cardiac masses. MRI can be used for localizing and characterizing abnormal hypermetabolic foci identified incidentally on PET scan and also for local staging. A recent advance in imaging technology has been the development of integrated PET/MRI systems that utilize the advantages of PET and MRI in a single examination. The goal of this manuscript is to provide a comprehensive review on the incremental value of PET and MRI in the evaluation of cardiovascular diseases. Main Messages • MRI has good spatial and temporal resolutions, tissue characterization, and multi-planar reconstruction • FDG-PET provides valuable information on the metabolic activity of cardiovascular disorders • PET and MRI provide complementary information on the evaluation of cardiovascular disorders Electronic supplementary material The online version of this article (doi:10.1007/s13244-016-0494-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hamid Chalian
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - James K O'Donnell
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Michael Bolen
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Prabhakar Rajiah
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA. .,Cardiothoracic Imaging, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390, USA.
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Takahashi A, Otsuka H, Harada M. Multimodal Cardiovascular Imaging of Cardiac Tumors. ACTA ACUST UNITED AC 2016. [DOI: 10.17996/anc.02.01.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ayaka Takahashi
- Department of Radiology, Tokushima University Graduate School
| | - Hideki Otsuka
- Department of Medical Imaging / Nuclear Medicine, Tokushima University Graduate School
| | - Masafumi Harada
- Department of Radiology, Tokushima University Graduate School
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