CMR in the Assessment of Cardiac Masses: Primary Malignant Tumors
Cardiac magnetic resonance (CMR) plays an important role in the assessment of cardiac tumors, since it combines high contrast and spatial resolution with a panoramic view of the heart and surrounding tissue, and has an excellent ability to characterize tissues. Thus, CMR assessment is frequently recommended to patients with cardiac masses to confirm the lesion, orient the diagnosis toward benign or malignant nature, and guide the subsequent patient management. To confirm the diagnosis of malignancy and to better characterize its nature, the acquisition of a perfusion study during contrast agent injection is recommended. Qualitative assessment of enhancement may help in the mass characterization, and moreover, semiquantitative analysis of enhancement curves provides additional criteria for the evaluation of tumor aggressiveness and for identification of cardiac malignancy. In cases when thrombotic lesions are suspected instead of malignancy, the acquisition of late gadolinium enhancement images with the specific choice of long inversion times (such as 600 ms), matching the null point of ‘avascular tissue,’ leads to a homogeneous hypointense appearance of thrombi clearly distinguishable from the surrounding myocardium.
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