Multiparametric mapping by cardiovascular magnetic resonance imaging in cardiac tumors

Abstract

Background There is a paucity of quantitative measurements of cardiac tumors and myocardium using parametric mapping techniques. This study aims to explore quantitative characteristics and diagnostic performance of native T1, T2, and extracellular volume (ECV) values of cardiac tumors and left ventricular (LV) myocardium. Methods Patients with suspected cardiac tumors who underwent cardiovascular magnetic resonance (CMR) between November 2013 and March 2021 were prospectively enrolled. The diagnoses of primary benign or malignant tumors were based on pathologic findings if available, comprehensive medical history evaluations, imaging, and long-term follow-up data. Patients with pseudo-tumors, cardiac metastasis, primary cardiac diseases, and prior radiotherapy or chemotherapy were excluded. Multiparametric mapping values were measured on both cardiac tumors and the LV myocardium. Statistical analyses were performed using independent-samples t-test, receiver operating characteristic, and Bland–Altman analyses. Results A total of 80 patients diagnosed with benign (n = 54), or primary malignant cardiac tumors (n = 26), and 50 age and sex-matched healthy volunteers were included. Intergroup differences in the T1 and T2 values of cardiac tumors were not significant, however, patients with primary malignant cardiac tumors showed significantly higher mean myocardial T1 values (1360 ± 61.4 ms) compared with patients with benign tumors (1259.7 ± 46.2 ms), and normal controls (1206 ± 44.0 ms, all P < 0.05) at 3 T. Patients with primary malignant cardiac tumors also showed significantly higher mean ECV (34.6 ± 5.2%) compared with patients with benign (30.0 ± 2.5%) tumors, and normal controls (27.3 ± 3.0%, all P < 0.05). For the differentiation between primary malignant and benign cardiac tumors, the mean myocardial native T1 value showed the highest efficacy (AUC: 0.919, cutoff value: 1300 ms) compared with mean ECV (AUC: 0.817) and T2 (AUC: 0.619) values. Conclusion Native T1 and T2 of cardiac tumors showed high heterogeneity, while myocardial native T1 values in primary malignant cardiac tumors were elevated compared to patients with benign cardiac tumors, which may serve as a new imaging marker for primary malignant cardiac tumors.

Benign or Malignant Cardiac Mass: Refining the Role of Cardiac Magnetic Resonance

“…The pathophysiological mechanisms underpinning these findings are not clear although microscopic infiltration of malignant tumors, activation of fibroblasts, compressive effects of the tumor, and tumor paracrine factors have all been proposed. 14 Clearly, these fascinating observations warrant future large multicenter multiparametric mapping studies.…”

“…In contrast to conventional tissue characterization, which relies on relative variations in signal intensities, multiparametric mapping allows direct assessment of T1, T2, and T2* and may offer an alternative to myocardial biopsies and laboratory biomarkers. 14,15 Yue et al 14 measured native (ie, noncontrast) T1, T2, and extracellular volume values in 80 patients undergoing CMR for suspected cardiac tumors (primary benign and malignant) and 50 age-and sex-matched controls. Conventional tissue characterization (T1/T2w, first-pass perfusion, and late gadolinium enhancement heterogeneity) did not demonstrate significant differences between the groups (presumably owing to the large tissue heterogeneity within the groups).…”