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The role of cardiac magnetic resonance in cardiac masses: a single centre experience

Session Poster session 2

Speaker Emanuela Concetta D'Angelo

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Cardiac Masses
  • Session type : Poster Session

Authors : EC D'angelo (Bologna,IT), D Guarino (Bologna,IT), G Vitale (Bologna,IT), A Foa (Bologna,IT), P Paolisso (Bologna,IT), M Coriano (Bologna,IT), L Di Marco (Bologna,IT), D Attina (Bologna,IT), L Lovato (Bologna,IT), V Russo (Bologna,IT), F Niro (Bologna,IT), O Leone (Bologna,IT), D Pacini (Bologna,IT), C Pizzi (Bologna,IT), N Galie (Bologna,IT)

EC D'angelo1 , D Guarino1 , G Vitale1 , A Foa1 , P Paolisso1 , M Coriano1 , L Di Marco2 , D Attina3 , L Lovato3 , V Russo3 , F Niro3 , O Leone4 , D Pacini2 , C Pizzi1 , N Galie1 , 1University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine - Bologna - Italy , 2University Hospital Policlinic S. Orsola-Malpighi, Cardiac Surgery Department of Experimental Diagnostic and Specialty Medicine - Bologna - Italy , 3University Hospital Policlinic S. Orsola-Malpighi, Cardiovascular and Thoracic Department Sant’Orsola- Malpighi - Bologna - Italy , 4University Hospital Policlinic S. Orsola-Malpighi, Department of Pathology - Bologna - Italy ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii373

BACKGROUND: Cardiac masses, which include benign and malignant primitive tumours, metastasis and pseudotumours, represent a challenging diagnostic issue. Cardiac Magnetic Resonance (CMR) is a very useful diagnostic tool for describing the morphologic and functional features of such masses. Pathological diagnosis is crucial in order to address specific therapeutic management. 
PURPOSE: To evaluate the diagnostic role of CMR in defining the nature of cardiac masses. 
METHODS: 50 patients with cardiac neoformations, pre-operatively evaluated with CMR during diagnostic work-up, were retrospectively enrolled. CMR sequences allowed a qualitative morphologic description as well as tissue characterization. Evaluation of masses morphology included localization, size and borders assessment, detection of potential multiple lesions and pericardial effusion; tissue characterization resulted from an estimation of contrast enhancement-including early gadolinium enhancement (EGE) sequences-and tissue homogeneity in T1 and T2 weighted acquisitions. Definite diagnosis was obtained with histologic examination of biopsy and/or surgical samples or, in cases of cardiac thrombi, throughout radiological evidence of thrombus resolution after adequate anticoagulant treatment. The descriptive analysis was carried out by comparing benign vs malignant lesions as well as dividing patients into 4 subgroups: primitive benign tumours (15 pts), primitive malignant tumours (11 pts), metastatic tumours (14 pts) and pseudotumours (10 pts). 
RESULTS The descriptive analysis of the morphologic features showed that a mass dimension > 5 cm, multiple localizations, ill-defined borders, and right heart localization (RHL) were able to predict malignancy (p value < 0.01). The subgroup analysis showed that primitive malignant lesions and metastatic tumours shared the same traits. In the univariate analysis a dimension greater than 5 cm and ill-defied borders had a rather satisfactory negative and positive predictive values (NPV 87% - PPV 75% for tumour dimensions and NPV 91% - PPV 94% for ill-defined borders). On the other hand, right heart localization was found to have a high NPV (83%) and a lower PPV (65%). T1 and T2-weighted heterogeneity and EGE were more common in malignant lesions (p value < 0.01). Furthermore, T1-weighted heterogeneity could exclude the presence of a pseudotumour but could not differentiate between types of neoplasia. Heterogeneity in EGE acquisitions was found to be more frequent in neoplasia rather than in pseudotumours (p<0.001). The multivariate analysis carried out on morphologic traits showed that only ill-defined borders were able to predict the malignancy of the mass (Odds ratio 74.6; p= 0.005). 
CONCLUSION: Cardiac magnetic resonance is a very useful diagnostic tool for differentiating benign and malignant heart lesions; in particular, the description of masses borders appears to be the most accurate variable in malignancy detection.

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