Echocardiography is the preferred initial imaging method for assessment of cardiac masses. Cardiac magnetic resonance (CMR) imaging, with its excellent tissue characterization and wide field of view, may provide additional unique information. We evaluated the predictive value of echocardiography and CMR imaging parameters to identify tumors and malignancy and to provide histopathologic diagnosis of cardiac masses. Fifty patients who underwent CMR evaluation of a cardiac mass with subsequent histopathologic diagnosis were identified. Echocardiography was available in 44 of 50 cases (88%). Echocardiographic and CMR characteristics were evaluated for predictive value in distinguishing tumor versus nontumor and malignant versus nonmalignant lesions using histopathology as the gold standard. The Wilcoxon rank-sum test was used to compare the 2 imaging methods' ability to provide the correct histopathologic diagnosis. Parameters associated with tumor included location outside the right atrium, T2 hyperintensity, and contrast enhancement. Parameters associated with malignancy included location outside the cardiac chambers, nonmobility, pericardial effusion, myocardial invasion, and contrast enhancement. CMR identified 6 masses missed on transthoracic echocardiography (4 of which were outside the heart) and provided significantly more correct histopathologic diagnoses compared to echocardiography (77% vs 43%, p <0.0001). In conclusion, CMR offers the advantage of identifying paracardiac masses and providing crucial information on histopathology of cardiac masses.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to American Journal of Cardiology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- WHO Classification of Tumours of Lung, Pleura, Thymus, and Heart.4th Edition. IARC, Lyon2015: 300
- Usefulness of magnetic resonance imaging of cardiac and paracardiac masses.Am J Cardiol. 2003; 92: 890-895
- Echocardiographic and pathologic characteristics of primary cardiac tumors: a study of 149 cases.Int J Cardiol. 2002; 84: 69-75
- Value of CMR for the differential diagnosis of cardiac masses.JACC Cardiovasc Imaging. 2014; 7: 896-905
- ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians.J Am Soc Echocardiogr. 2011; 24: 229-267
- Primary cardiac tumors: experience with 30 consecutive patients since the introduction of two-dimensional echocardiography.J Am Coll Cardiol. 1985; 5: 1465-1473
- Diagnosis of noninfective cardiac mass lesions by two-dimensional echocardiography. Comparison of the transthoracic and transesophageal approaches.Circulation. 1991; 83: 70-78
- Non-Hodgkin lymphoma.Lancet. 2003; 362: 139-146
- Visualization of ventricular thrombi with contrast-enhanced magnetic resonance imaging in patients with ischemic heart disease.Circulation. 2002; 106: 2873-2876
- Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation.Am Heart J. 2006; 152: 75-84
- Primary tumors of the heart.in: Bonow R.O. Mann D.L. Zipes D.P. Libby P. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Saunders, Philadelphia2012: 1638-1650
Published online: October 19, 2015
Accepted: October 9, 2015
Received in revised form: October 9, 2015
Received: August 14, 2015
This project was supported by grant number K12HS019473 from the Agency for Healthcare Research and Quality (Rockville, Maryland).
See page 140 for disclosure information.
Published by Elsevier Inc.