CMR Imaging in Suspected Cardiac Tumor

Quick Takes

  • CMR has high accuracy in excluding a cardiac tumor.
  • CMR offers a unique ability to differentiate between various diagnostic possibilities, particularly thrombus versus tumor.
  • CMR correctly distinguished benign from malignant tumors, owing to its excellent soft tissue contrast and high spatial resolution.

Study Questions:

What is the prognostic value of the “real-world” cardiovascular magnetic resonance (CMR) diagnosis in patients clinically referred to CMR for suspected cardiac tumor?

Methods:

In this multicenter study of patients undergoing clinical CMR for suspected cardiac tumor, the study investigators assigned CMR diagnoses as no mass, pseudomass, thrombus, benign tumor, or malignant tumor. A final diagnosis was determined after follow-up using all available data. The primary endpoint was all-cause mortality. Kaplan–Meier survival analyses and Cox proportional hazards regression analyses were used to evaluate the relationships between CMR diagnostic categories and death.

Results:

A total of 935 patients formed the study cohort. Thirty-two (3%) patients had a CMR diagnosis of “Other.” Among these, 14 had valve-associated vegetations, but otherwise, the possible diagnoses were heterogeneous, and these 32 patients were, therefore, excluded from further analyses by the study investigators. Among 903 patients, the CMR diagnosis was no mass in 25%, pseudomass in 16%, thrombus in 16%, benign tumor in 17%, and malignant tumor in 23%. Over a median of 4.9 years, 376 patients died. Compared with the final diagnosis, the CMR diagnosis was accurate in 98.4% (368/374) of patients. On Cox proportional hazards regression analysis, age (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.04–1.13 per 5-year increase), smoking (HR, 1.37; 95% CI, 1.11–1.69), CMR left ventricular ejection fraction (LVEF) (HR, 1.05; 95% CI, 1.01–1.10 per 5% decrease), extracardiac malignancy (HR, 2.32; 95% CI, 1.81–2.97), CMR diagnosis of thrombus (HR, 1.46; 95% CI, 1.00–2.11 relative to CMR diagnosis of no mass), and CMR diagnosis of malignant tumor (HR, 3.31; 95% CI, 2.40–4.57 relative to CMR diagnosis of no mass) were independently associated with mortality. The CMR diagnosis provided incremental prognostic value over clinical factors including LVEF, coronary artery disease, and history of extracardiac malignancy (significantly increased the χ2 statistic from 215.8 to 299.8; p < 0.001).

Conclusions:

The study authors concluded that in patients with suspected cardiac tumor, CMR has high diagnostic accuracy. Patients with CMR diagnoses of no mass, pseudomass, and benign tumor have similar long-term mortality and the CMR diagnosis is a powerful independent predictor of mortality incremental to clinical risk factors.

Perspective:

This is an important study because it is the largest imaging study to date for the diagnosis of cardiac tumor and confirms the high accuracy of CMR, previously reported in smaller cohorts in whom cardiac tumors were known to be present. Another important finding of this study is that CMR also has high accuracy in excluding a cardiac tumor. This study confirms that CMR is, indeed, the gold standard for anyone suspected to have a cardiac tumor. The next step would be to perform a head-to-head comparison of echocardiography versus CMR in all-comers with suspected cardiac tumor and to utilize newer CMR techniques including T1 and T2 mapping.

Clinical Topics: Cardiac Surgery, Cardio-Oncology, Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Coronary Artery Disease, Interventions and Imaging, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Smoking

Keywords: Cardiac Surgical Procedures, Carcinoid Tumor, Cardiotoxicity, Coronary Artery Disease, Diagnostic Imaging, Echocardiography, Geriatrics, Heart Failure, Heart Neoplasms, Magnetic Resonance Imaging, Risk Factors, Secondary Prevention, Smoking, Stroke Volume, Thrombosis, Ventricular Function, Left


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