Author + information
- Received July 9, 2013
- Revision received October 22, 2013
- Accepted November 1, 2013
- Published online July 1, 2014.
- Antonio Esposito, MD∗ (, )
- Francesco De Cobelli, MD,
- Gabriele Ironi, MD,
- Paolo Marra, MD,
- Tamara Canu, RT,
- Renata Mellone, MD and
- Alessandro Del Maschio, MD
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- ↵∗Address for correspondence
: Dr. Antonio Esposito, Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
Cardiac magnetic resonance (CMR) plays an important role in the assessment of cardiac tumors, because it combines high contrast and spatial resolution with a panoramic view of the heart and surrounding structures and an unmatched ability to characterize tissues. So, CMR assessment with dedicated protocols (Fig. 1) is frequently recommended to patients with cardiac masses, to confirm the lesion, orient the diagnosis toward the benign or malignant nature, and guide the subsequent patient management.
A selection of images collected in the last 5 years from the archives of our institution is presented to underline the distinguishing aspects of the most frequent primary cardiac tumors and pseudo-masses at CMR; in particular, the CMR images of primary benign cardiac tumors are included and discussed in this paper (Figs. 2 to 6⇓⇓), while the images of primary cardiac malignancies and pseudo-masses will be presented in an upcoming issue of iJACC. Each figure is provided with a 3-line header that sums up peculiar CMR findings.
Main aspects to be considered for helping in the comprehension of mass composition and biological aggressiveness include:
• Signal intensity
• Pattern of enhancement at the dynamic contrast-enhanced study
CMR allows a multiparametric approach for the characterization of cardiac masses:
• Cine steady state free precession (SSFP) sequences offer a first morpho-functional evaluation with a balanced T1/T2 effect. SSFP sequences have high spatial and temporal resolution and are particularly useful to evaluate the mobility of a lesion and its impact on cardiac contractility or valves function.
• The variable acquisition of multiplanar “black blood” T1-weighted, T2-weighted, and/or proton density–weighted sequences, which can also be preceded by saturation pulses to suppress fat signal, allows a more accurate understanding of the size and the extension of the lesion as well as of mass composition.
• The perfusion study offers both qualitative and quantitative information about tumor vascularization (1).
• Late gadolinium enhancement of the lesion, detected acquiring inversion recovery sequences several minutes after gadolinium injection, might help in distinguishing small or large fibrotic components, which are frequent in benign conditions such as fibromas, fibroelastomas, and rarely myxomas (2).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 9, 2013.
- Revision received October 22, 2013.
- Accepted November 1, 2013.
- American College of Cardiology Foundation