Cardiac Masses, Part 1: Imaging Strategies and Technical Considerations

Abstract

OBJECTIVE The objective of this article is to discuss optimal imaging strategies for the evaluation of cardiac masses. The advantages and disadvantages of echocardiography, cardiac MRI, gated cardiac CT, and nuclear imaging will be discussed and specific techniques presented. CONCLUSION Multimodality imaging plays a pivotal role in the diagnosis and surgical planning of cardiac masses. Clinical features, such as patient age, location, and imaging characteristics of the mass will determine the likely differential diagnosis.

Cardiac MR assessment of cardiac myxomas

“…5 Owing to their characteristically long inversion time, thrombi will appear dark on these sequences, whereas myxomas, with a typical inversion time of between 200-300 ms, will not. 5 Although myxomas tend to be more mobile, have a narrower base of attachment to the wall of the cardiac chamber and arise at different locations, there is considerable overlap of these features between thrombus and myxoma. 6,7 Prolapse through the atrioventricular valve is a common feature of myxomas but not of thrombi.…”

“…3 Echocardiography is usually the initial imaging modality used in the assessment of a suspected cardiac mass but remains rather operator dependent with a restricted field of view and can be particularly challenging in patients with large body habitus. 2,4,5 Cardiac MRI (CMR) enables accurate assessment of the location and functional impact of cardiac masses in any imaging plane without exposing patients to ionizing radiation. 2,5 In particular, CMR performs better than echocardiography at determining the nature of cardiac lesions and can differentiate myxomas from thrombus.…”

“…2,4,5 Cardiac MRI (CMR) enables accurate assessment of the location and functional impact of cardiac masses in any imaging plane without exposing patients to ionizing radiation. 2,5 In particular, CMR performs better than echocardiography at determining the nature of cardiac lesions and can differentiate myxomas from thrombus. 2,5 Given that most cardiac lesions are not easily amenable to catheter-directed biopsy, accurate imaging differentiation of cardiac myxomas from other types of cardiac masses is of vital importance in guiding further management.…”

“…2,4,5 Although there is significant variation in signal characteristics, the majority of myxomas will return intermediate signal on T 1 weighted sequences and high signal intensity on T 2 and fat-saturated T 2 weighted sequences (Figures 2 and 5). 3,4 The different composition of myxoid tissue, fibrous tissue, blood and haemorrhagic breakdown products contained within myxomas result in significant variability of the signal characteristics exhibited by these lesions on CMR.…”

A Patient with Lung Squamous Cell Carcinoma Presenting with Severe Cardiac Dysfunction Similar to Dilated Cardiomyopathy with Left Bundle Branch Block Induced by Myocardial Metastasis

“…Several recent reports demonstrate the utility of imaging studies such as cardiac MRI, CT and 18 Ffluorodeoxyglucose positron emission tomography / CT (FDG-PET/CT) to detect cardiac metastasis (11)(12)(13)(14). However, we were unable to perform any of these tests in the present case.…”