Multimodality diagnostic imaging for anomalous pulmonary venous connections: a pictorial essay

Anomalous pulmonary venous connections represent a heterogeneous group of congenital heart diseases in which a part or all pulmonary venous flow drains directly or indirectly into the right atrium. Clinically, anomalous pulmonary venous connections may be silent or have variable consequences, including neonatal cyanosis, volume overload and pulmonary arterial hypertension due to the left-to-right shunt. Anomalous pulmonary venous connections are frequently associated with other congenital cardiac defects and their accurate diagnosis is crucial for treatment planning. Therefore, multimodality diagnostic imaging, comprising a combination (but not all) of echocardiography, cardiac catheterization, cardiothoracic computed tomography and cardiac magnetic resonance imaging, helps identify potential blind spots relevant to each imaging modality before treatment and achieve optimal management and monitoring. For the same reasons, diagnostic imaging evaluation using a multimodality fashion should be used after treatment. Finally, those interpreting the images should be familiar with the various surgical approaches used to repair anomalous pulmonary venous connections and the common postoperative complications.

Coronary artery changes in congenital coronary-cameral fistulas evaluated by computed tomographic angiography

PURPOSE

The study sought to determine coronary artery diameter in congenital coronary-cameral fistula (cCCF), factors associated with coronary artery aneurysm, coronary artery changes after fistula closure, and computed tomographic (CT) findings after treatment.

MATERIALS AND METHODS

We retrospectively reviewed CT findings of the cCCF for origins, terminations, fistula length, complexities, and Sakakibara classification. Coronary artery diameter was expressed as coronary artery Z score. Fistula features associated with coronary artery aneurysm were analyzed. Post-fistula closures were analyzed for coronary artery dilatation, coronary thrombosis, complete fistula closure, and fistula thrombosis.

RESULTS

Twenty-five patients (median age 33 months, interquartile range, IQR 25-48) were included. Coronary feeders and terminations were frequently right coronary artery (48%) and right ventricle (56%), respectively. Fistula aneurysm occurred in 52% of cases. Mean coronary artery Z score was 13.03 ± 6.36 with a high incidence of giant coronary artery aneurysm (68%). We found no statistically significant risk factors associated with coronary artery aneurysm (p value range 0.075-0.370). Median duration of the follow-up CT after closure of the fistulas was 6.4 months (IQR 5.0-8.7). Coronary artery Z score significantly decreased by 0.82 (IQR 0.28-1.35), p = 0.006 and coronary thrombosis occurred in 23% of cases during follow-up.

CONCLUSIONS

Large coronary aneurysm is common in cCCF. No characteristic feature of the fistula influencing coronary artery aneurysm is identified. There is a diminution in coronary artery Z score after fistula closure. Coronary thrombosis is a major complication after treatment.

Correlating computed tomographic angiography of pulmonary circulation with clinical course and disease burden in patients with tetralogy of Fallot and pulmonary atresia

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Pulmonary circulation in patients with TOF and pulmonary atresia can be extremely complex.

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The type of pulmonary circulation correlates with arborization of the pulmonary artery.

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There is a relationship between type of pulmonary circulation and number of MAPCAs.

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The morphology of pulmonary circulation determines the successful corrective surgery.

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All patients carry risk from serial diagnostic imaging and palliative management.

Purpose

To determine the type of pulmonary circulation (PC) in patients with tetralogy of Fallot (TOF) and pulmonary atresia (TOF-PA) with the use of computed tomographic angiography (CTA), and describe their clinical courses, corrective surgery and disease burden.

Methods

145 patients (median age 4 years, interquartile range: IQR2-8 years) were analyzed for PC which divided into 5 CTA-types and 11 subtypes based on presence of main pulmonary trunk (MPA) and confluent pulmonary arteries (confluence-PAs), presence of ductus arteriosus or major aortopulmonary collateral arteries (MAPCAs), respectively. Pulmonary arteries (PAs) were assessed by McGoon ratio and arborization. Corrective surgery or palliative management was recorded by type of PC. Disease burden was calculated as the sum of CTA, diagnostic angiography, and palliative management.

Results

The most common (N = 77, 53 %) PC was the presence of MPA with confluent-PAs (type-1) which was encountered mostly in TOF patients, followed by the presence of confluent-PAs with atretic MPA (type-2) (N = 47, 32 %) which found mainly in TOF-PA. McGoon ratio in type-1 (2.44 ± 0.84) was significantly larger than type-2 (1.61 ± 0.61) (median difference 0.84, 95 %CI 0.56–1.11, p < 0.001). Almost 2/3 of patients in type-1 (71 %) and 1/3 of patients in type-2 (34 %) achieved corrective surgery. There was no significant difference in amount of disease burden among the different PC, with the median value of 3 (IQR1-4).

Conclusions

Types of PC allow suggestions for size and arborization of PAs and successful surgical correction with an inverse relationship with the numbers of MAPCAs. There is no significant difference in amount of disease burden among the types of PC.

Follow-up aortic dilatation in patients with repaired tetralogy of Fallot using cardiovascular magnetic resonance

Purpose

The study sought to determine the rate of aortic expansion and correlation with somatic growth in patients with repaired tetralogy of Fallot (rTOF), and predictors for determining the annual growth rate of the aorta (Ao-AGR).

Methods

Ninety-four rTOF patients (mean age 14.5 ± 4.4 years) with two cardiac magnetic resonance tests (CMR) (median duration 52 months, interquartile range, IQR 24-71) were analyzed for aortic diameter (AoD) at the annulus, the sinus of Valsalva (SoV), the sinotubular junction, and the ascending aorta (AAo), and compared with the normal limit AoD (NL-AoD) values. The median age-at-repair was 60 months (IQR 36-84). Ao-AGR and its index (Ao-AGRI) were derived from changes of the AoD and AoD-index, respectively, divided by the duration between the two studies. Three potential predictors (baseline AoD, sex, and age-at-repair) for the progression of Ao-AGR were analyzed.

Results

There was a significant larger AoD than NL-AoD (p < 0.001). Slow aortic growth was encountered in 78-85 % of patients. The Ao-AGR was slow, the median AGR ranged from 0.37 mm (IQR 0.13-0.72) at annulus to 0.56 mm (IQR 0.22-0.91) at AAo. There was a regression in Ao-AGRI, ranged from -1.41 mm (IQR -1.94, -0.87) at annulus to -2.36 mm (IQR -3.09, -1.63) at SoV. The three predictors were not correlated with severity of Ao-AGR.

Conclusion

Most adolescents with rTOF show significant aortic dilatation. There is a slow Ao-AGR with regression of Ao-AGRI, which may suggest that the rate of aortic growth is slower than the somatic growth. There are no significant predictors of the progression of Ao-AGR.

Pediatric Cardiothoracic CT Guideline Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 2. Contemporary Clinical Applications

The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limited to the morphologic evaluation of the extracardiac thoracic vessels, lungs, and airways. Currently, the applications of CT have increased, owing to technological advancements in hardware and software as well as several dose-reduction measures. In the previously published part 1 of the guideline by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed the prerequisite technical knowledge for clinical applications in a user-friendly and vendor-specific manner. Herein, we present the second part of our guideline on contemporary clinical applications of pediatric cardiothoracic CT for CHD based on the consensus of experts from the Asian Society of Cardiovascular Imaging CHD Study Group. This guideline describes up-to-date clinical applications effectively in a systematic fashion.

Magnetic resonance imaging assessment of aortic dilatation and distensibility in 269 patients with repaired tetralogy of Fallot

PURPOSE

To determine the prevalence and degree of aortic dilatation (A_dilatation), severity of aortic stiffness (A_stiff), factors for A_dilatation, and level of aortic root most sensitive to A_stiff in patients with repaired tetralogy of Fallot (rTOF).

MATERIALS AND METHODS

269 patients with rTOF (mean age 14.9 ± standard deviation 5.0 years) were analyzed for A_dilatation at annulus, sinus, sinotubular junction, and ascending aorta (aAo). Aortic size index was graded as Z score < 2, 2-2.99, 3-4.99 and ≥ 5. Aortic distensibility (aA_dis) was categorized according to 4 aortic levels and dilatation severity. Factors for A_dilatation and level of aortic root most sensitive to A_stiff were analyzed.

RESULTS

Sinus and aAo were the two most common sites of A_dilatation, with a prevalence of 84% and 76%, respectively. A decreased aA_dis was found (mean 5.38 ± 1.79 10^-3 mmHg^-1). aA_dis only declined significantly at the sinus level (p = 0.009). Male sex, age-at-repair and aortic regurgitation were significant factors for A_dilatation, with male sex as the strongest factor (odds ratio 2.94). There was a significant decline in aA_dis at sinus level (p = 0.002) as A_dilatation progressed.

CONCLUSIONS

We observed a high prevalence of A_dilatation and A_stiff in patients with rTOF. Male sex is the strongest factor for A_dilatation. The sinus is the most sensitive area for determining a negative aA_dis effect.

CT and MRI for Repaired Complex Adult Congenital Heart Diseases

An increasing number of adult congenital heart disease (ACHD) patients continue to require life-long diagnostic imaging surveillance using cardiac CT and MRI. These patients typically exhibit a large spectrum of unique anatomical and functional changes resulting from either single- or multi-stage palliation and surgical correction. Radiologists involved in the diagnostic task of monitoring treatment effects and detecting potential complications should be familiar with common cardiac CT and MRI findings observed in patients with repaired complex ACHD. This review article highlights the contemporary role of CT and MRI in three commonly encountered repaired ACHD: repaired tetralogy of Fallot, transposition of the great arteries after arterial switch operation, and functional single ventricle after Fontan operation.

Prevalence and predictors of cardiac and liver iron overload in patients with thalassemia: A multicenter study based on real-world data

Prevalence of cardiac and liver iron overload in patients with thalassemia in real-world practice may vary among different regions especially in the era of widely-used iron chelation therapy. The aim of this study was to determine the prevalence of cardiac and liver iron overload in and the management patterns of patients with thalassemia in real-world practice in Thailand. We established a multicenter registry for patients with thalassemia who underwent magnetic resonance imaging (MRI) as part of their clinical evaluation. All enrolled patients underwent cardiac and liver MRI for assessment of iron overload. There were a total of 405 patients enrolled in this study. The mean age of patients was 18.8±12.5years and 46.7% were male. Two hundred ninety-six (73.1%) of patients received regular blood transfusion. Prevalence of cardiac iron overload (CIO) and liver iron overload (LIO) was 5.2% and 56.8%, respectively. Independent predictors for iron overload from laboratory information were serum ferritin and transaminase for both CIO and LIO. Serum ferritin can be used as a screening tool to rule-out CIO and to diagnose LIO. Iron chelation therapy was given in 74.6%; 15.3% as a combination therapy.

Asian consortium on radiation dose of pediatric cardiac CT (ASCI-REDCARD)

BACKGROUND

With incremental utilization of pediatric cardiac CT in congenital heart disease, it is imperative to define its current radiation dose levels in clinical practice in order to help imagers optimize CT protocols, particularly in Asia and other developing countries where CT physicists are not readily available.

OBJECTIVE

To evaluate current radiation dose levels and influencing factors in cardiac CT in children with congenital heart disease in Asia by conducting a retrospective multi-center, multi-vendor study.

MATERIALS AND METHODS

We included 1,043 pediatric cardiac CT examinations performed in 8 centers between January 2014 and December 2014 to evaluate congenital heart disease. In five weight groups, we calculated radiation dose metrics including volume CT dose index, size-specific dose estimate, dose-length product and effective dose. Age at CT exam, gender, tube voltage, scan mode, CT indication and image reconstruction algorithm were analyzed to learn whether they influenced CT radiation dose.

RESULTS

Volume CT dose index, size-specific dose estimate, dose-length product and effective dose of pediatric cardiac CT showed variations in the range of 4.3-23.8 mGy, 4.9-17.6 mGy, 55.8-501.3 mGy∙cm and 1.5-3.2 mSv, respectively, within five weight groups. Gender, tube voltage, scan mode and cardiac function assessment significantly influenced CT radiation dose.

CONCLUSION

This multi-center, multi-vendor study demonstrated variations in radiation dose metrics of pediatric cardiac CT reflecting current practice in Asia. Gender, tube voltage, scan mode and cardiac function assessment should be considered as essential radiation dose-influencing factors in developing optimal pediatric cardiac CT protocols.

A comparative study: right ventricular assessment in post-repaired tetralogy of Fallot patients by echocardiogram with cardiac magnetic resonance imaging

BACKGROUND

Post-repaired Tetralogy of Fallot (TOF) patients require comprehensive evaluation of the right ventricular (RV) size and function. Currently, cardiac magnetic resonance imaging (CMR) is considered to be the gold standard for RV function assessment. Echocardiogram (ECHO) is the most useful non-invasive tool for RV assessment. However, correlations of ECHO and CMR findings for this particular group of patients require further evaluation.

OBJECTIVE

The first objective is to assess the correlation between RV size/function, measured by ECHO and CMR. The second objective is to investigate ECHO parameters that correlate best with RV end diastolic volume index (RVEDVi) of 160 mL/m2 from CMR.

MATERIAL AND METHOD

The present study recruited 20 TOF patients (mean age 14 ± 2 years) who underwent right ventricular outflow tract reconstruction and/or pulmonary valve replacement for at least 5 years, from June 2011 to March 2012. The RV was initially evaluated with CMR, followed by ECHO within 3 months. ECHO parameters measured were tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), area of right ventricular end diastole index (area RVEDi), RV free wall myocardial performance index (RVMPI), and qualitative assessment of pulmonary valve regurgitation (PR). All ECHO parameters were compared with CMR measurements of right ventricular ejection fraction (RVEF), RVEDVi and quantitative assessment of PR. Comparative analysis were assessed by Pearson's sample correlation coefficient, Kappa, and sensitivity and specificity of RVEDi area from ROC curve analysis.

RESULTS

Results showed significant correlations between RVEDVi and area RVEDi (R = 0.768, p < 0.01), RVEF with FAC (R = 0.759, p < 0.01), and RVEF with TAPSE (R = 0.688, p < 0.01). Hundred percent correlation was found in moderate to severe PR assessment by ECHO and CMR (Kappa = 0.912). Abnormal RVMPI was not correlated with NYHA FC, CXR and ECG (Kappa = -0.10, 0.15, -0.04). The area RVEDi ≥ 20.43 cm2/m2 correlated well with RVEDVi ≥ 160 mL/m2 (sensitivity 64%, specificity 83%) from ROC curve analysis.

CONCLUSION

ECHO is an effective tool for RV evaluation in post-repaired TOF with PR. FAC, TAPSE and severity of PR from ECHO correlated well with CMR parameters. Measurement of area RVEDi from ECHO is the best parameter to predict RVEDVi from CMR.

Cardiac CT angiography in children with congenital heart disease

Cardiac imaging plays an important role in both congenital and acquired heart diseases. Cardiac computed tomography (angiography) cCT(A) is a non-invasive, increasingly popular, complementary modality to echocardiography in evaluation of congenital heart diseases (CHD) in children. Despite radiation exposure, cCT(A) is now commonly used for evaluation of the complex CHD, giving information of both intra-cardiac and extra-cardiac anatomy, coronary arteries, and vascular structures. This review article will focus on the fundamentals and essentials for performing cCT(A) in children, including radiation dose awareness, basic techniques, and strengths and weaknesses of cCT(A) compared with cardiac magnetic resonance imaging (cMRI), and applications. The limitations of this modality will also be discussed, including the CHD for which cMRI may be substituted.

Transcoronary bone marrow-derived progenitor cells in a child with myocardial infarction: first pediatric experience

BACKGROUND

Recent advances in stem cell therapy to restore cardiac function have great promise for patients with congestive heart failure after myocardial infarction in an adult population.

OBJECTIVE

We examined the benefits of bone marrow-derived progenitor cells treatment modality for the pediatric patient.

METHODS AND RESULTS

We present our first case of transcoronary autologous stem cell transplantation in a 9-year-old girl with refractory congestive heart failure secondary to myocardial infarction 1 year after transcatheter revascularization. The child received daily injections of granulocyte colony-stimulating factor for 3 days prior to the bone marrow aspiration. The bone marrow cells were isolated to constitute CD133+/CD34+ more than 90% of the total number. Subsequently, the progenitor cell suspension was injected via a transcoronary catheter without any complication. Three months after stem cell therapy, her cardiac function, assessed by both cardiac magnetic resonance and echocardiogram, has been improved with the left ventricular ejection fraction at 47% compared to the baseline of 30%.

CONCLUSION

This is the first reported pediatric case of successful transcoronary injection of bone marrow-derived progenitor cells for end-stage heart disease. The procedure is considered safe and feasible for the pediatric population.

Hepatocellular adenoma: a case report

A case of hepatocellular adenoma (HCA) was described in a 26-year-old woman, who was a potential kidney donor for her father and denied taking the oral contraceptive pill. A hypervascular mass of 4.1 cm in largest dimension was detected in the liver segment V by computerized tomography and magnetic resonance imaging (MRI). The normal levels of liver enzymes, negative serum markers for hepatitis viruses, and non-elevated alpha- fetoprotein level were detected. The wedge resection of segment V was done with an uneventful clinical course. In Western countries, HCAs are known to occur in women in their reproductive periods. It may not be associated with oral contraceptive. Molecular biological studies disclosed three variants of HCAs, i.e., I) with mutation of HNF 1-alpha gene, II) with mutation of beta-catenin gene, and III) no mutation of the two genes. Histological correlations with the three variants as recommended by the Bordeaux group in 2007 could not be accomplished in the present study due to overlapping histological features between the variants I and III. The etiological factors of HCA are known to relate to the contraceptive pill usage in female and the anabolic-androgenic-steroid administration in male. In Thailand, the occurrence of HCA is expected to be only 0.3% of cases with hepatocellular carcinoma.

Inflammatory myofibroblastic tumor ofabdomen: computerized tomographic (CT) and pathological findings

Inflammatory Myofibroblastic Tumor (IMT) is the recent name of Inflammatory pseudotumor which was in intermediate group of fibrous-origin tumor. The authors retrospectively reviewed such cases in Ramathibodi Hospital from January 2001 to December 2005. There were 115 cases of fibrous-origin tumor which was IMT in 17 cases. Nine cases occurred in the abdomen and only 3 of these had complete computerized tomographic (CT) imaging. One was hypodense liver mass with thick rim enhancement. Another one in the liver presented as a liver abscess which appeared as multiloculated hypodense mass with enhanced septum. The third case was a large malignant-looking retroperitoneal mass and having a small accompanying hepatic lesion which rapidly grew in the follow up study at nine months. IMT in the abdomen was scanty. The diagnosis was done with difficulty because of different signs and symptoms such as fever and palpable abdominal mass. The laboratory findings were nonspecific or within normal limits. Tissue biopsy was the way of definite diagnosis. We reported 3 cases of abdominal IMT with variable imaging findings that may lead to inappropriate treatment. Recognization of such findings will help achieve correct diagnosis.

N-terminal pro-brain natriuretic peptide as a marker in follow-up patients with tetralogy of Fallot after total correction

Patients with tetralogy of Fallot (TOF) after total correction usually have residual pulmonary regurgitation resulting in right ventricular (RV) dilatation and dysfunction. This study was performed to evaluate N-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting RV dilatation and RV dysfunction in TOF after total correction. Twenty-one patients with TOF after total correction (12 males and 9 females, 12.06 +/- 2.54 years old) underwent echocardiography, cardiac magnetic resonance imaging (MRI), and blood sampling for NT-proBNP. Mean time after total correction was 7.59 +/- 2.30 years. From cardiac MRI study, mean right ventricular end diastolic volume index (RVEDVi) was 148.36 +/- 64.50 ml/m2 and mean right ventricular ejection fraction (RVEF) was 35.50 +/- 10.50%. Right ventricular dilatation was considered if RVEDVi was >108 ml/m2 and RV dysfunction was considered if RVEF was <40%. A plasma NT-proBNP level of 115 pg/ml was identified by receiver operating characteristic analysis in predicting RV dilatation and/or dysfunction. At this value, the sensitivity and specificity for predicting RV dilatation, RV dysfunction, and both RV dilatation and dysfunction were 71 and 100%, 71 and 71%, and 83 and 78%, respectively. In conclusion, plasma NT-proBNP level may be helpful in follow-up patients. Plasma NT-proBNP levels >115 pg/ml can be used as a marker in the detection of RV dilatation and dysfunction.

Cardiovascular examination with 3.0 Tesla magnetic resonance imaging: first 100 cases at Ramathibodi Hospital

BACKGROUND

Cardiovascular magnetic resonance imaging (CMR) has been utilized for diagnosis in various cardiovascular diseases and most of those were performed on a 1.5 Tesla CMR system. Recently, a 3.0 Tesla magnetic resonance imaging system has been introduced into clinical practice, however the clinical experience on cardiovascular examination using this system is limited. Therefore, the authors' institution has integrated a team for developing a CMR program on this 3.0 Tesla system.

OBJECTIVE

To describe the authors' experience on the 3.0 Tesla CMR system.

MATERIAL AND METHOD

The data on patients referred to the authors' CMR unit between August 2004 and October 2005 were reviewed.

RESULTS

One hundred patients were referred for CMR examination. The mean age was 56 years (2 month - 85 years) and 65 patients were male. The most common indication was to assess coronary artery disease (64 patients). The performed examination was divided into cardiac structure and function assessment (39%), stress testing (23%), coronary magnetic resonance angiography (13%), myocardial viability assessment (12%), magnetic resonance angiography (9%), and flow assessment (4%).

CONCLUSION

The present study highlights that comprehensive assessment of various cardiovascular diseases can be performed on the 3.0 Tesla CMR system.

Diagnosis of tetralogy of Fallot with anatomically corrected malposition of the great arteries and single coronary artery by multidetector CT

We present a case of an 8-year-old boy diagnosed as a tetralogy of Fallot with anatomically corrected malposition of the great arteries by echocardiography and cardiac catheterization. Multidetector CT nicely elucidated the course of the single coronary artery from the right coronary cusp, which traverses across the right ventricular outflow tract.

Measurement of in vivo myocardial microcirculatory function with electron beam CT

PURPOSE

The purpose of this work was to examine the capability of electron beam CT (EBCT) to characterize responses of recruitable (capillaries and small arterioles) compared with nonrecruitable (small to large arterioles) myocardial microvessels to vasoactive substances.

METHOD

Myocardial perfusion (F) and total intramyocardial blood volume (BV) of the anterior cardiac wall were quantitated in 36 pigs, using EBCT and intravenous contrast agent injections, before and after intracoronary administration of either NG-monomethyl-L-arginine (L-NMMA), nitroglycerin, adenosine, or saline. Plotting the relationship of BV and F provided values for the recruitable and nonrecruitable microvascular transit times and BV allotment.

RESULTS

Nitroglycerin increased nonrecruitable BV by 84.5+/-7.4%, whereas adenosine increased both recruitable and nonrecruitable microvascular BV (47.1+/-18.9 and 66.0+/-10.9%, respectively). L-NMMA led to a 25.1% decrease only in the recruitable BV. In the control group, no changes were observed.

CONCLUSION

Characteristic responses of different-size myocardial microvessels may be inferred with EBCT, which provides a unique opportunity to portray intramyocardial microcirculatory function noninvasively.

Utilization of electron beam CT scan in diagnosis of pulmonary embolism

Pulmonary embolism is a difficult entity to diagnose clinically and pulmonary angiogram has been the gold standard for the diagnosis. Our objective was to evaluate the usefulness of electron beam (Ultrafast) CT scan in aiding the diagnosis of such an entity, thus avoiding an invasive procedure. Between April 1995 and March 1996 we prospectively studied 20 patients with clinical suspicion of pulmonary embolism by conventional perfusion scan of the lung, by invasive pulmonary angiography and by contrast enhanced electron beam CT scan. Simple statistic correlation between the 3 methods was obtained in regard to sensitivity and specificity utilizing the pulmonary angiogram as the gold standard. The sensitivity and specificity of contrast enhanced electron beam CT scanning was 95 per cent and 100 per cent respectively. The correlation of positive and negative result of all three imaging modalities was 60 per cent. Contrast enhanced electron beam (Ultrafast) CT scan is a good alternative diagnostic modality for pulmonary embolism.

MRI of primary malignant cardiovascular tumors

PURPOSE

The purpose of this study was to describe the MR features of primary malignant cardiac tumors, which may aid in differentiation from primary benign cardiac tumors.

METHOD

Seven patients with primary malignant cardiac tumor were imaged with MR. All studies were performed on a 1.5 T MR imager using variable combinations of SE T1-weighted cine gradient MR and post-Gd-DTPA SE T1-weighted MR with fat saturation sequences. The following features were analyzed on images: length of attachment to cardiac structures, size of tumors, involvement of more than one chamber, extension to pericardium or beyond the heart, and necrosis of the mass.

RESULTS

All cases had a wide point of attachment. Six of the seven tumors were large in size and occupied almost the entire cardiac chamber. There was involvement of more than one cardiac chamber or great vessel in three patients. Pericardial or extracardiac extension occurred in four and two patients, respectively. Tumor necrosis was evident in two patients. All patients had at least one of these signs of malignant tumor.

CONCLUSION

Primary malignant cardiac tumors have distinctive MR features that can be used to differentiate them from primary benign cardiac tumors.