Cardiac fibromas typically arise in the ventricular myocardium, most commonly the ventricular septum, as found in our cases, or the left ventricular free wall [1,6]. Often, this localization induces conduction system disease with resulting rhythm abnormalities, as well as in our patients.
In our little sample, the cardiac fibromas were in all cases homogeneous.
However, the presence of intralesional calcification is described in the literature, which can be seen as patchy hypointense foci within the lesion [7,8].
According to the literature, they showed little or no enhancement during the early phases after the administration of intravenous contrast, because of their avascularity. However, the hyperenhancement on LGE reflected an increased extracellular volume of masses [9,10] (Fig. 7).
Fig. 7: Fig. 7: the hyperenhancement of the fibroma on LGE reflected an increased extracellular volume of masses (ECV 41% v.n. 23-26%)
Fig. 7
T2 hypointensity was suggestive of fibromas.
The T1 native values of the tumor were not particularly altered but always different from healthy segments in the same patient, allowing to differentiate it from myocardial tissue.
As expected, ECV was markedly increased in fibromas, in some cases even reaching values of 90% due to the large extracellular volume present in these tumors, which is rich in collagen (Fig. 8).
Fig. 8: Fig. 8: ECV is markedly increased in fibromas: in this patient is of 90% due to the large extracellular volume present in these tumors, which is rich in collagen
Fig. 8
These CMR characteristics are consistent with a diagnosis of fibroma and allow to differentiate this lesion from other tumors.
Quantitative parametric T1 mapping and ECV calculation techniques could expand CMR imaging repertoire for the differentiation of cardiac masses based on tissue characterization. These techniques demonstrate a unique ability to achieve noninvasive in vivo characterization of cardiac fibromas. T1-mapping and ECV associated with CMR standard protocol seem to be a promising approach for a comprehensive assessment of cardiac masses.