1
|
Haider I, Ullah H, Fatima M, Karim MS, Haq FU, Majid A, Anwar MS, Nawaz FK, Ali I, Sarwar AH, Anwar MT, Khan AW, Humayun O, Alam F. Tissue characterization of benign cardiac tumors by cardiac magnetic resonance imaging, a review of core imaging protocol and benign cardiac tumors. Front Cardiovasc Med 2023; 10:1009411. [PMID: 37441708 PMCID: PMC10333494 DOI: 10.3389/fcvm.2023.1009411] [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: 08/05/2022] [Accepted: 04/18/2023] [Indexed: 07/15/2023] Open
Abstract
Generally, cardiac masses are initially suspected on routine echocardiography. Cardiac magnetic resonance (CMR) imaging is further performed to differentiate tumors from pseudo-tumors and to characterize the cardiac masses based on their appearance on T1/T2-weighted images, detection of perfusion and demonstration of gadolinium-based contrast agent uptake on early and late gadolinium enhancement images. Further evaluation of cardiac masses by CMR is critical because unnecessary surgery can be avoided by better tissue characterization. Different cardiac tissues have different T1 and T2 relaxation times, principally owing to different internal biochemical environments surrounding the protons. In CMR, the signal intensity from a particular tissue depends on its T1 and T2 relaxation times and its proton density. CMR uses this principle to differentiate between various tissue types by weighting images based on their T1 or T2 relaxation times. Generally, tumor cells are larger, edematous, and have associated inflammatory reactions. Higher free water content of the neoplastic cells and other changes in tissue composition lead to prolonged T1/T2 relaxation times and thus an inherent contrast between tumors and normal tissue exists. Overall, these biochemical changes create an environment where different cardiac masses produce different signal intensity on their T1- weighted and T2- weighted images that help to discriminate between them. In this review article, we have provided a detailed description of the core CMR imaging protocol for evaluation of cardiac masses. We have also discussed the basic features of benign cardiac tumors as well as the role of CMR in evaluation and further tissue characterization of these tumors.
Collapse
Affiliation(s)
- Imran Haider
- Radiology Department, Saint Luke’s Hospital, Chesterfield, MO, United States
| | - Hameed Ullah
- Internal Medicine Department, Hayatabad Medical Complex (HMC), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | | | | | - Furqan Ul Haq
- Internal Medicine Department, Mayo Hospital, Lahore, Punjab, Pakistan
| | - Abdul Majid
- Department of Radiation Oncology, Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Saad Anwar
- Internal Medicine Department, King Edward Medical University, Lahore, Punjab, Pakistan
| | - Fatima Kausar Nawaz
- Sheikh Zayed Medical College, Pakistan
- Khyber Girls Medical College, Peshawar, Pakistan
| | - Ijaz Ali
- Internal Medicine Department, Hayatabad Medical Complex (HMC), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Atif Hussain Sarwar
- Internal Medicine Department, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College Hospital: Shaikh Zayed Hospital, Lahore, Pakistan
| | - Muhammad Tayyab Anwar
- Internal Medicine Department, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Abdul Wali Khan
- Internal Medicine Department, Gujranwala Medical College, Gujranwala, Punjab, Pakistan
| | - Omama Humayun
- Internal Medicine Department, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | | |
Collapse
|
2
|
Motwani M, Kidambi A, Herzog BA, Uddin A, Greenwood JP, Plein S. MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology 2013; 268:26-43. [PMID: 23793590 DOI: 10.1148/radiol.13121239] [Citation(s) in RCA: 239] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardiac masses are usually first detected at echocardiography. In their further evaluation, cardiac magnetic resonance (MR) imaging has become a highly valuable technique. MR imaging offers incremental value owing to its larger field of view, superior tissue contrast, versatility in image planes, and unique ability to enable discrimination of different tissue characteristics, such as water and fat content, which give rise to particular signal patterns with T1- and T2-weighted techniques. With contrast material-enhanced MR imaging, additional tissue properties such as vascularity and fibrosis can be demonstrated. MR imaging can therefore contribute to the diagnosis of a cardiac mass as well as be used to detail its relationship to other cardiac and extracardiac structures. These assessments are important to plan therapy, such as surgical intervention. In addition, serial MR studies can be used to monitor tumor regression after surgery or chemotherapy. Primary cardiac tumors are very rare; metastases and pseudotumors (eg, thrombus) are much more common. This article provides an overview of cardiac masses and reviews the optimal MR imaging techniques for their assessment.
Collapse
Affiliation(s)
- Manish Motwani
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, England
| | | | | | | | | | | |
Collapse
|
3
|
van Werkum MH, Swaans MJ, van Es HW, Rensing B, van Heesewijk JPM. Case 190: papillary fibroelastoma of the pulmonary valve. Radiology 2013; 266:680-4. [PMID: 23362097 DOI: 10.1148/radiol.12110495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michiel H van Werkum
- Departments of Radiology and Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
| | | | | | | | | |
Collapse
|
4
|
|
5
|
Salanitri J, Lisle D, Rigsby C, Slaughter R, Edelman R. Benign cardiac tumours: cardiac CT and MRI imaging appearances. J Med Imaging Radiat Oncol 2009; 52:550-8. [PMID: 19178628 DOI: 10.1111/j.1440-1673.2008.02010.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Primary benign cardiac tumours are rarely found in clinical practice and are generally evaluated with echocardiography. However, with the increasing usage of helical multislice CT, the initial detection and evaluation of these masses may be made by the radiologist during routine daily practice for other indications. The echocardiographic, CT and cardiac MRI appearances of various benign cardiac tumours and masses are described and illustrated in this review.
Collapse
Affiliation(s)
- J Salanitri
- Department of Medical Imaging, St Andrews Hospital, Spring Hill, Brisbane, Australia.
| | | | | | | | | |
Collapse
|
6
|
Abstract
Magnetic resonance (MR) imaging is an important tool in the evaluation of cardiac neoplasms. T1-weighted, T2-weighted, and gadolinium-enhanced sequences are used for anatomic definition and tissue characterization, whereas cine gradient-echo imaging is used to assess functional effects. Recent improvements in pulse sequences for cardiac MR imaging have led to superior image quality, with reduced motion artifact and improved signal-to-noise ratio and tissue contrast. Although there is some overlap in the MR imaging appearances of cardiac tumors, particularly of primary malignancies, differences in characteristic locations and features should allow confident differentiation between benign and malignant tumors. Indicators of malignancy at MR imaging are invasive behavior, involvement of the right side of the heart or the pericardium, tissue inhomogeneity, diameter greater than 5 cm, and enhancement after administration of gadolinium contrast material (as a result of higher tissue vascularity). Concomitant pericardial or pleural effusions are rare in benign processes but occur in about 50% of cases of malignant tumors. MR imaging offers improved resolution, a larger field of view, and superior soft-tissue contrast compared with those of echocardiography, suggesting that knowledge of the MR imaging features of cardiac neoplasms is important for accurate diagnosis and management.
Collapse
Affiliation(s)
- Patrick J Sparrow
- British Heart Foundation Cardiac MRI Unit, Room 170, D Floor, Jubilee Wing, The General Infirmary, Leeds LS1 3EX, England
| | | | | | | |
Collapse
|
7
|
Abstract
The use of magnetic resonance (MR) imaging for cardiac diagnosis is expanding, aided by the administration of paramagnetic contrast agents for a growing number of clinical applications. This overview of the literature considers the principles and applications of cardiac MR imaging with an emphasis on the use of contrast media. Clinical applications of contrast material-enhanced MR imaging include the detection and characterization of intracardiac masses, thrombi, myocarditis, and sarcoidosis. Suspected myocardial ischemia and infarction, respectively, are diagnosed by using dynamic first-pass and delayed contrast enhancement. Promising new developments include blood pool contrast media, labeling of myocardial precursor cells, and contrast-enhanced imaging at very high fields.
Collapse
Affiliation(s)
- Robert R Edelman
- Department of Radiology, Evanston Northwestern Healthcare, 2650 Ridge Ave, Evanston, IL 60201, USA.
| |
Collapse
|
8
|
Schneider G, Fries P, Ahlhelm F, Kindermann I, Kramann B, Böhm M. Contrast-enhanced cardiac MR imaging. Eur Radiol 2004; 13 Suppl 3:N11-8. [PMID: 15015876 DOI: 10.1007/s00330-003-0002-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- G Schneider
- Department of Diagnostic Radiology, University Hospital, Homburg/Saar, Germany
| | | | | | | | | | | |
Collapse
|
9
|
Patel MR, Thomson LEJ, Meine TJ, Heitner J, Burfeind WR, Messier RH, Corey GR, Kim RJ. An intracardiac mass in a young man with congenitally acquired HIV. Cardiol Rev 2004; 12:126-30. [PMID: 15078579 DOI: 10.1097/01.crd.0000107895.39892.9e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of a 19-year-old man with congenitally acquired HIV infection who was found to have a large intracardiac mass is presented. Presurgical imaging studies and subsequent pathologic findings and histology are discussed.
Collapse
Affiliation(s)
- Manesh R Patel
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Hoffmann U, Globits S, Schima W, Loewe C, Puig S, Oberhuber G, Frank H. Usefulness of magnetic resonance imaging of cardiac and paracardiac masses. Am J Cardiol 2003; 92:890-5. [PMID: 14516903 DOI: 10.1016/s0002-9149(03)00911-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In this study, magnetic resonance imaging was compared with histology to evaluate the usefulness of magnetic resonance imaging to distinguish malignant from benign cardiac and paracardiac masses in 55 patients. Tumor location, tissue composition, and pericardial or pleural effusion all were identified as key predictors of lesion type. Observers were accurate in the prediction of lesion type (area under curve 0.88 and 0.92), and there was good interobserver variability (Cohen's kappa = 0.64).
Collapse
Affiliation(s)
- Udo Hoffmann
- Department of Radiology, General Hospital and University of Vienna, Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
11
|
Kaminaga T, Takeshita T, Kimura I. Role of magnetic resonance imaging for evaluation of tumors in the cardiac region. Eur Radiol 2003; 13 Suppl 6:L1-10. [PMID: 16440217 DOI: 10.1007/s00330-002-1789-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2002] [Revised: 09/17/2002] [Accepted: 12/09/2002] [Indexed: 10/26/2022]
Abstract
The aim of this study was to review the role of MRI in the assessment of heart neoplasm, 25 cases with heart neoplasm (10 myxoma, 6 rhabdomyoma, 5 angiosarcoma, 2 mesothelioma, 1 lymphoma, and 1 fibroma) were examined with MRI and echocardiography. Multislice T1- and T2-weighted spin-echo images and static gradient-echo images were taken in appropriate directions with electrocardiogram gating. Gadolinium enhancement was performed in 21 cases. Transthoracic echocardiography was performed in all cases. Except for the 5 patients with rhabdomyoma, the pathological diagnosis was obtained. MRI proved to be useful for tissue characterization of myxoma, angiosarcoma, mesothelioma, and fibroma in cases with tuberous sclerosis. MRI also proved to be useful for detection of the tumor, depiction of contour, relation with other cardiac structures, in cases with myxoma, angiosarcoma, mesothelioma, lymphoma, and fibroma. In the differential diagnosis, MRI provided important information in cases with myxoma, rhabdomyoma, angiosarcoma, and fibroma. In cases with tumors expanding into the mediastinum, such as mesothelioma and fibroma in this report, MRI was useful in determining the location and border. In cases with tumors adjacent to pericardium, MRI was useful in detecting pericardial invasion. Gadolinium enhancement added useful information in cases with myxoma, rhabdomyoma, angiosarcoma, and mesothelioma. The role of MRI with and without Gd enhancement differs somewhat in individual types of heart neoplasm, and adaptation must be considered in each kind of neoplasm. On the other hand, MRI is an essential examination in all cases with a cardiac mass, which has not been diagnosed, since it may provide useful information for the differential diagnosis.
Collapse
Affiliation(s)
- Tatsuro Kaminaga
- Department of Radiology/Pathology, Teikyo University Medical School, 2-11-1, Kaga, Itabashi-ku, 1738605, Tokyo, Japan.
| | | | | |
Collapse
|
12
|
Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR. Cardiac myxoma: imaging features in 83 patients. Radiographics 2002; 22:673-89. [PMID: 12006696 DOI: 10.1148/radiographics.22.3.g02ma02673] [Citation(s) in RCA: 212] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Eighty-six cardiac myxomas were reviewed retrospectively for the clinical, pathologic, and radiologic findings. In this series, 83 patients (47 female and 36 male; age range, 2-78 years; mean age, 48 years) had 49 left atrial (60%), 23 right atrial (28%), seven right ventricular (8%), two biatrial, and two cases of multifocal myxomas. Seventy-one (88%) patients were symptomatic. Radiographs of 38 patients with left atrial myxoma showed evidence of mitral valve obstruction in 53%; radiographs of 16 patients with right atrial myxoma demonstrated calcification and cardiomegaly in 56% and 50%, respectively. Computed tomographic (CT) scans of 21 myxomas demonstrated 20 (95%) spherical or ovoid lesions, 16 (76%) with lobular borders. Seventeen (81%) were hypoattenuated; 14 (67%) were heterogeneous. Twenty-eight magnetic resonance (MR) imaging studies of 30 myxomas showed 29 (97%) spherical or ovoid lesions; 26 (87%) had lobular contours and 26 (90%) of 29 had heterogeneous signal intensity on T1-weighted images. Point of attachment was visible in 15 (83%) cases. Cine gradient recalled echo (GRE) MR images of 10 lesions showed low signal intensity in all cases. Most patients with cardiac myxomas have abnormal but usually nonspecific radiographic findings. CT demonstrates intracavitary heterogeneous, hypoattenuated lobular masses. MR imaging shows heterogeneous lobular lesions and usually allows visualization of the point of attachment. Radiologic imaging of these lesions, particularly with multiplanar and cine GRE MR imaging, can provide accurate assessment of the size, location, and point of attachment of these lesions and should assist in surgical planning.
Collapse
Affiliation(s)
- Mary L Grebenc
- Department of Radiology, U.S. Naval Hospital Roosevelt Roads, Puerto Rico, PSC 1008, Box 177, FPO, AA 34051-3007, USA.
| | | | | | | | | |
Collapse
|
13
|
Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR. Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation. Radiographics 2000; 20:1073-103; quiz 1110-1, 1112. [PMID: 10903697 DOI: 10.1148/radiographics.20.4.g00jl081073] [Citation(s) in RCA: 331] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Primary cardiac and pericardial neoplasms are rare lesions and include both benign and malignant histologic types. Myxoma is the most frequent primary cardiac neoplasm, but other benign tumors include papillary fibroelastoma, rhabdomyoma, fibroma, hemangioma, lipoma, and paraganglioma. Cardiac sarcoma represents the second most common primary cardiac neoplasm. Lymphoma can also affect the heart primarily. Pericardial tumors that affect the heart include benign teratomas and malignant mesotheliomas. Patients affected with cardiac or pericardial neoplasms often present with cardiovascular compromise or embolic phenomena and exhibit cardiomegaly at chest radiography. Benign cardiac tumors typically manifest as intracavitary, mural, or epicardial focal masses, whereas malignant tumors demonstrate invasive features and may involve the heart diffusely. Benign lesions can usually be successfully excised, but patients with malignant lesions have an extremely poor prognosis.
Collapse
Affiliation(s)
- M L Grebenc
- Department of Radiology, National Naval Medical Center, Bethesda, MD, USA
| | | | | | | | | |
Collapse
|
14
|
Puvaneswary M, Edwards JR, Bastian BC, Bellamy GR, Khatri SK. Atrial myxoma demonstrated by cine gradient refocused echo magnetic resonance imaging. AUSTRALASIAN RADIOLOGY 2000; 44:208-11. [PMID: 10849988 DOI: 10.1046/j.1440-1673.2000.00786.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of atrial myxoma presenting with syncope evaluated by echocardiography and MRI is described. Cine gradient-echo MRI demonstrated atrial myxoma as a very low signal intensity mass indicating the presence of haemosiderin.
Collapse
Affiliation(s)
- M Puvaneswary
- Department of Medical Imaging, John Hunter Hospital, New South Wales, Australia
| | | | | | | | | |
Collapse
|