Diagnostic Value of Cardiac MRI in Comparison to Trans-Thoracic Echocardiography in Detection and Characterization of Cardiac Masses

Marzie Motevalli; Kaveh Shokri

doi:10.5812/iranjradiol.21261

Abstract

Background:

Cardiac masses are uncommon and encompass a spectrum of lesions with different histological features. Despite rarity, serious complications associated with these lesions render the need for a sensitive, specific, and accurate diagnostic tool which may lead to treatment options such as cardiac surgery as a major invasive intervention.

Objectives:

The purpose of this study was to compare accuracy and specificity of trans-thoracic echocardiography (TTE) and cardiac MRI (CMRI) as the two non-invasive diagnostic methods available.

Patients and Methods:

Thirty-eight patients who were suspected to have cardiac or pericardiac space occupying lesions on TTE were included in this study. CMRI protocols include steady cine imaging, HASTE and 3D-IR FLASH sequences after contrast (Gd-chelate) administration in first pass and delayed images added to common CMRI sequences (T1 and T2 TSE)

Results:

Of the 38 subjects, 27 (PPV, 68.4%) had findings in CMRI in favor of SOL (other studies were either normal or suggestive of other disorders such as cardiomyopathies). Of these, 18 were solid masses and 9 were either cystic mass lesions or clots. In view of CMRI findings and clinical indications, 20 patients underwent operation and for all of them the diagnosis of SOL lesions was confirmed (no false positive). On CMRI, 11 cardiac tumors had findings suggestive of malignancy, which was consistent with the histopathology results in 10 operated patients (specificity, 90.9% of tissue diagnosis). CMRI features in 7 patients were in favor of indeterminate or benign lesions with a PPV of 83.3% after histological comparison (6 masses were resected). Five lesions which were suspected of being neoplastic masses on TTE, turned out to be endocardial vegetations or thrombi on CMRI (PPV, 78%). In five patients who underwent CMRI for characterization of cystic lesion detected by TTE, findings of both modalities were almost consistent with each other with a superior precision in CMRI characterization. Invasion to adjacent organs or remote organs involvement was detected in 7 patients, completely compatible with intra-operational observations and/or further investigations (specificity, 100%).

Conclusions:

CMRI with specific sequences and multiplanar image is by far the most accurate non invasive modality in detection and evaluation of mass lesions in and around heart.

Keywords

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