Imaging myocardial carcinoid with T2-STIR CMR

Abstract

We used T2-STIR (Short Tau Inversion Recovery) cardiovascular magnetic resonance to demonstrate carcinoid tumor metastases to the heart and liver in a 64-year-old woman with a biopsy-proven ileal carcinoid tumor who was referred because of an abnormal echocardiogram. Case presentationA 64-year-old Middle-Eastern woman was referred to our center for cardiovascular magnetic resonance (CMR) for further evaluation of basal inferior left ventricular (LV) wall thickening that was detected by transthoracic echocardiography done in her home country. The echocardiogram was done to search for cardiac valvular manifestations of a biopsy-proven ileal carcinoid tumor. Multiple CMR imaging sequences were obtained which demonstrated that the basal inferior LV wall thickening was composed of an intramyocardial mass. In addition, there was another smaller (9 mm diameter) intramyocardial mass in the free wall of the right ventricle (RV) and there were multiple masses in the liver. All of these cardiac and hepatic masses had the same magnetic resonance imaging characteristics. Neither the RV mass nor the hepatic masses were reported to be detected by echocardiography. The CMR sequence which best distinguished the metastatic carcinoid cardiac and hepatic tumors from surrounding normal tissue in this case was T2-weighted Short Tau Inversion Recovery (T2-STIR). In addition, CMR demonstrated the absence of carcinoid valvular thickening. In this case, information learned from CMR, guided cardiac surgical and oncologic consultants' clinical decisions. CMR methods and findingsScans were carried out using a Siemens Sonata 1.5 Tesla scanner. Initial localizer images using electrocardiographically-gated Half-Fourier Acquisition Single-shot Turbo spin Echo (HASTE) showed multiple hepatic metastases up to 65 mm × 60 mm in size, and a large intramyocardial mass (43 mm × 35 mm × 32 mm) in the basal inferior wall of the LV. Cine balanced Steady State Free Precession images demonstrated that the intramyocardial mass had fused with the posterior leaflet of the mitral valve, restricting its motion and causing moderate mitral regurgitation. A small amount of pericardial effusion surrounding the mass was noted, but there was no evidence of extension of the mass into the pericardial space.A T2-weighted Short Tau Inversion Recovery (T2-STIR) sequence revealed the LV intramyocardial mass to have a high signal intensity which indicates a high water content that could be caused by active inflammation and/or edema. The same high signal intensity signal was noted in the hepatic masses. A small spherical intramyocardial mass (9 mm in diameter) with the same high signal intensity was identified in the free wall of the right ventricle (RV), which had not been detected by echocardiography nor identified as distinctly by other CMR sequences (Fig.

ENETS Consensus Guidelines for the Management of Brain, Cardiac and Ovarian Metastases from Neuroendocrine Tumors

“…Some cardiac metastases only present as wall thickening and may be difficult to identify with echocardiography. As a single method, MRI is superior to echocardiography in the detection and quantification of cardiac metastases [25,[39][40][41] . Octreoscan or SPECT/CT may be helpful in somatostatin-receptor-positive lesions [23,42] , but when used alone lacks fine discrimination and cannot provide definitive anatomical localization.…”

A Chemerin Peptide Analog Stimulates Tumor Growth in Two Xenograft Mouse Models of Human Colorectal Carcinoma

“…While these results may appear contradictory, it is conceivable that the growth-enhancing effect of the chemerin analog depends on signaling only active in a three-dimensional cell context. It has been established that cells adapt to their environment by reacting to local signals, which in turn results in changes in cell proliferation and other physiological functions [ 36 ]. Still, one limitation of this study is the lack of a mechanistic explanation for the differential regulation by chemerin in 2D versus 3D cultures.…”

Multimodality Imaging Findings in Carcinoid Tumors: A Head-to-Toe Spectrum

“…The average age at diagnosis of myocardial metastases is 58.2 years (range, 39-68 years), with the mean size of metastasis ranging from 0.35 to 2.4 cm (38). Metastases are mostly intramyocardial; however, they can also involve the pericardium and rarely cause conduction abnormalities with or without associated valvular thickening (40).…”

“…The metastatic lesions are isointense on T1weighted images and show high signal intensity on T2-weighted short inversion time inversion-recovery images indicating high water content caused by active inflammation and/or edema, which also results in contrast enhancement (40). Cardiac MR imaging can also demonstrate the presence or absence of carcinoid valvular thickening.…”