Cardiac Mass: Algorithms For An Integrative Diagnostic Approach

Transcription

1 Cardiac Mass: Algorithms For An Integrative Diagnostic Approach Poster No.: C-0729 Congress: ECR 2012 Type: Educational Exhibit Authors: M. A. SAEED KILANI 1, V. Gaxotte 2, M. Midulla 1, J. P. Beregi 3 ; Lille/FR, Paris/FR, Nîmes/FR Keywords: DOI: Tissue characterisation, Neoplasia, Diagnostic procedure, MR, CT, Cardiovascular system, Cardiac /ecr2012/C-0729 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 10

2 Learning objectives To settle diagnostic algorithms to be used in the everyday clinical practice aiming at integrating clinical and radiological data in order to guide the diagnostic work-up of a cardiac mass based on typical imaging features and most common clinical presentations. Background Cardiac Tumors - Prevalence of primary cardiac tumors is between % and 0.03 %. - Clinical presentation is non-specific and very variable % of primary cardiac tumors are benign. - Myxoma is the most common primary cardiac tumor. The majority of myxomas develop in the atria with 75% occurring on the left side and 15%-20% occurring on the right side. Most arise from a narrow attachment point at the fossa ovalis of the interatrial septum but they can originate from any endocardial surface, including the ventricles and heart valves. - Angiosarcoma accounts for the majority of primary malignant lesions. - Cardiac metastases are usually encountered in end-stage disease and their prevalence is times higher than primary malignant cardiac tumors. Differential diagnosis. - In patients with ejection fraction < 50% the prevalence of thrombi is estimated to 7%. - Morbidity and mortality of cardiac tumors and thrombi are significant. - Many anatomical variants and technical artifacts may result in confusion to the inexperienced observer and must be recognized to avoid unnecessary intervention. Imaging. - CMR has become the gold standard imaging modality of cardiac masses due to its high soft tissue contrast resolution and ability of tissue characterization. - CT is highly sensitive for detection of intra-tumoral calcifications. Page 2 of 10

3 - Accurate confirmation of the presence of a suspected mass lesion, its localization, and assessment of the extent of involvement, evaluation of the functional impact of the lesion are important not only for diagnosis but also in determination of prognosis and in planning of therapy, including surgical resection. - Imaging only is sometimes unable to characterize the cardiac mass due to lack of specific features. Imaging findings OR Procedure details - Four diagnostic algorithms were constructed from the literature data based on the location of the lesion and its imaging features. - Clinical context, relevant biological information and age of the patient were taken in consideration to guide the diagnostic orientation. - Attention was given to differentiate true tumors from tumor-like lesions, anatomical variants or artifacts. - Important anatomical variants: 1. The Crista terminalis is a vertically orientated fibromuscular ridge that runs along the posterior aspect of the right atrium and gives rise to the pectinate muscles, which fan out anteriorly. 2. The moderator band extends across the right ventricle and contains the right bundle branch; it is a defining feature of the right ventricle. ** These structures should not be mistaken for an intracardiac mass. - Note that sometimes atypical imaging features of a malignant mass may simulate a benign one and vice versa. These atypical presentations are too heterogenous and variable to be included in these algorithms. Images for this section: Page 3 of 10

4 Fig. 1: Algorithm of diagnostic approach for a non-infiltrating intracavitary cardiac mass in a patient with no known primary neoplasm. (+ve : positive; -ve : negative) Page 4 of 10

5 Fig. 2: Algorithm of diagnostic approach for a pericardiac mass in patient with no known primary neoplasm. Mediastinal masses infiltrating the pericardium are not considered in this algorithm. Page 5 of 10

6 Fig. 3: Algorithm of diagnostic approach for a non-infiltrating (mass involving only one layer of the heart) intramyocardial mass. IAS : Inter-Atrial Septum; AV : Atrio-Ventricular; HTN : Hypertension) Page 6 of 10

7 Fig. 4: Algorithm of diagnostic approach for an infiltrating cardiac mass. Page 7 of 10

8 Conclusion This electronic poster proposed an integrated diagnostic approach for a suspected cardiac mass to reduce the differential diagnoses or to make a specific diagnosis whenever possible. Personal Information References 1. Lam KY, D.P., Chan AC, Tumors of the heart. A 20-year experience with a review of consecutive autopsies. Arch Pathol Lab Med, : p Chiles C, W.P., Gutierrez FR, et al., Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics 2001(21): p Jeffrey T. Lund, R.L.E., Paul R. Julsrud, Lawrence J. Sinak, Abdul J. Tajik, Cardiac Masses: Assessment by MR Imaging. AJR, 1989(152): p Philip A. Araoz, H.E.E., Timothy J. Welch and Jerome F. Breen, CT and MR Imaging of Primary Cardiac Malignancies. RadioGraphics, 1999(19): p Antonio Luna, R.R., Pilar Caro, José Vida, Jeremy J. Erasmus, Evaluation of cardiac tumors with magnetic resonance imaging. Eur Radiol, : p Patrick J. Sparrow, J.B.K., Tim R. Jones, Mohan U. Sivananthan, MR Imaging of Cardiac Tumors. RadioGraphics, 2005(25): p K.N. Boddy, M.M.S., C.D. Sammarco, C. Weisse, S. Ghods, and H.I. Litt, Cardiac Magnetic Resonance in the Differentiation of Neoplastic and Nonneoplastic Pericardial Effusion. J Vet Intern Med, 2011: p Kiran Randhawa, A.G.a.E.T.D.H., Magnetic Resonance Imaging of Cardiac Tumors: Part 1, Sequences, Protocols, and Benign Tumors. Curr Probl Diagn Radiol, : p Sandra Fussen, B.W.L.D.B., Michael J. Zellweger, Jens Bremerich, Kaatje Goetschalckx, Michel Zuber and Peter T. Buser, Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours. Eur Heart J, (12): p Page 8 of 10

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