Learning objectives
To present primary malignant cardiac tumors (PMCT) evaluated on MRI in Slovakia in the last 11 years
To show the diagnostic algorithm in MRI differentiation of cardiac masses
To explore howPMCTtissue characteristictranslatesinto MRI features
Background
PMCTs are very rare. Incidence varies among published studies around 0,0095-0,009.9%[1].
75% of PMCTs are sarcomas, the rest include lymphomas and pericardial mesotheliomas [2].
MR imaging reliably allows assessing the morphology, anatomy, tissue characteristics, and functional impact of cardiac tumors.
Cardiac mass on MRI– questions to answer:
1.Benign versus malignant?
MRI features suggesting malignancy:
Right heart chambers
Involve more than 1 chamber
Broad-based attachment
>5 cm
Ill-defined margins
Hemorrhagic pericardial effusion
Heterogeneous appearance
First-pass perfusion enhancement
Heterogeneous late gadolinium enhancement (LGE) [3].
2.Malignant tumors: Primary...
Findings and procedure details
Presented PMCT - MRI findings according to final histopathology diagnosis:
Case 1:
59 y/o male: cardiac mass, filling right ventricle (RV).Fig. 1
Typical localization for a “focal variety” type of angiosarcoma
Typical inhomogeneous character (necrosis) for angiosarcoma
Infiltration of RV wall – malignant feature
Findings of metastasis (axilla, liver) at the time of diagnosis
On the base of the medical history of an axillary mass with histology of metastatic angiosarcomaandMRI findings,the “focal variety” type of angiosarcoma was proposed and confirmed histologically.
Case 2:
18 y/o...
Conclusion
Due to its supreme tissue contrast, MRI is the imaging tool of choice in differentiating cardiac masses with relatively high diagnostic accuracy.
Since the prevalence of primary malignant cardiac tumors is very low, it is very important for radiologists to be aware of them and know their MR manifestation.
Personal information and conflict of interest
Z. Berecova; Bratislava/SK - nothing to disclose D. Juskanic; Nitra/SK - nothing to disclose A. Glezlova; Trencin/SK - nothing to disclose J. Simkova; Trnava/SK - nothing to disclose C. Gibarti; Kosice/SK - nothing to disclose J. Grebac; Bratislava/SK - nothing to disclose E. Drangova; Bratislava/SK - nothing to disclose J. Polakova Mistinova; Bratislava/SK - nothing to disclose M. D. V. Neuschl; Trnava/SK - nothing to disclose
References
YReardon MJ, DeFelice CA, Sheinbaum R, et al. Cardiac autotransplant for surgical treatment of a malignant neoplasm.Ann Thorac Surg1999;67:1793-5.
He S, Cao Y, Qin W, et al.Prevalence of primary cardiac tumor malignancies in retrospective studies over six decades: a systematic review and meta-analysis. Oncotarget2017;8(26):43284-43294.
Hoey E, Shahid MS, Ganeshan A, et al. MRI assessment of cardiac tumors: part 2, spectrum of appearances of histologically malignant lesions and tumor mimics.Quant Imaging Med Surg2014;4(6):489-497.
Sparrow PJ, Kurian JB, Jones TR, et al. MR Imaging of Cardiac Tumors.RadioGraphics...
