Assessment of Cardiac Masses by Cardiac Magnetic Resonance Imaging: Histological Correlation and Clinical Outcomes

Abstract

Background Cardiac magnetic resonance imaging ( CMR ) provides useful information for characterizing cardiac masses, but there are limited data on whether CMR can accurately distinguish benign from malignant lesions. We aimed to describe the distribution and imaging characteristics of cardiac masses identified by CMR and to determine the diagnostic accuracy of CMR for distinguishing benign from malignant tumors. Methods and Results We examined consecutive patients referred for CMR between May 2008 and August 2013 to identify those with a cardiac mass. In patients for whom there was histological correlation, 2 investigators blinded to all data analyzed the CMR images to categorize the mass as benign or malignant. For benign masses, readers were also asked to specify the most likely diagnosis. Benign masses were defined as benign neoplastic or non‐neoplastic. Malignant masses were defined as primary cardiac or metastatic. Of 8069 patients (mean age: 58±16 years; 55% female) undergoing CMR , 145 (1.8%) had a cardiac mass. In most cases (142, 98%), there was a known cardiac mass before the CMR study. Among 145 patients with a cardiac mass, 93 (64%) had a known history of malignancy. Among 53 cases that had histological correlation, 25 (47%) were benign, 26 (49%) were metastatic, and 2 (4%) were malignant primary cardiac masses. Blinded readers correctly diagnosed 89% to 94% of the cases as benign versus malignant, with a 95% agreement rate (κ=0.83). Conclusions Although C MR can be highly effective in distinguishing benign from malignant lesions, pathology remains the gold standard in accurately determining the type of mass.

Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio‐Oncology Council of the European Society of Cardiology (ESC)

“…79 Additionally, CMR is an excellent test for the comprehensive evaluation of pericardial diseases, cardiac masses, infiltrative (amyloidosis) as well as storage diseases. 80,81 .…”

Medical management of a suspected atrial myxoma in a nonagenarian

“…It provides superior tissue characterization by differentiating myxomas from thrombus, and benign from malignant lesions, without exposure to ionizing radiation. 12,13 The patient's overall presentation was consistent with that of heart failure with preserved ejection fraction (HFpEF) exacerbation. The etiology was considered multifactorial and likely contributed by a pseudo-stenotic effect of the myxoma, hypertensive urgency, and atrial fibrillation with a rapid ventricular response, which may or may not have been related to the myxoma.…”

Left Atrial Thrombi Masquerading as Myxomas: Mini Case Series and Literature Review

“…[12][13][14] Cardiac computed tomography and cardiac magnetic resonance imaging are viable options when echocardiographic findings are inconclusive or technically inadequate, but they are not failure proof. [15][16][17][18] Despite the high accuracy of cardiac magnetic resonance in establishing the nature of cardiac masses, on occasion, thrombi confirmed by histology have been misclassified as myxomas. 16,18 Contrast echocardiographic perfusion imaging has been proposed as an excellent tool in diagnosing cardiac masses given its ability to differentiate vascular tumors, which exhibit contrast enhancement, from avascular masses such as thrombi.…”