Accuracy of Cardiac Magnetic Resonance Imaging in Diagnosing Pediatric Cardiac Masses: A Multicenter Study

JACC Cardiovasc Imaging. 2022 Aug;15(8):1391-1405. doi: 10.1016/j.jcmg.2021.07.010. Epub 2021 Aug 18.

Abstract

Background: After diagnosis of a cardiac mass, clinicians must weigh the benefits and risks of ascertaining a tissue diagnosis. Limited data are available on the accuracy of previously developed noninvasive pediatric cardiac magnetic resonance (CMR)-based diagnostic criteria.

Objectives: The goals of this study were to: 1) evaluate the CMR characteristics of pediatric cardiac masses from a large international cohort; 2) test the accuracy of previously developed CMR-based diagnostic criteria; and 3) expand diagnostic criteria using new information.

Methods: CMR studies (children 0-18 years of age) with confirmatory histological and/or genetic diagnosis were analyzed by 2 reviewers, without knowledge of prior diagnosis. Diagnostic accuracy was graded as: 1) single correct diagnosis; 2) correct diagnosis among a differential; or 3) incorrect diagnosis.

Results: Of 213 cases, 174 (82%) had diagnoses that were represented in the previously published diagnostic criteria. In 70% of 174 cases, both reviewers achieved a single correct diagnosis (94% of fibromas, 71% of rhabdomyomas, and 50% of myxomas). When ≤2 differential diagnoses were included, both reviewers reached a correct diagnosis in 86% of cases. Of 29 malignant tumors, both reviewers indicated malignancy as a single diagnosis in 52% of cases. Including ≤2 differential diagnoses, both reviewers indicated malignancy in 83% of cases. Of 6 CMR sequences examined, acquisition of first-pass perfusion and late gadolinium enhancement were independently associated with a higher likelihood of a single correct diagnosis.

Conclusions: CMR of cardiac masses in children leads to an accurate diagnosis in most cases. A comprehensive imaging protocol is associated with higher diagnostic accuracy.

Keywords: cardiac magnetic resonance; cardiac mass; cardiac tumor; pediatric.

Publication types

  • Multicenter Study

MeSH terms

  • Child
  • Contrast Media*
  • Gadolinium
  • Heart Neoplasms* / diagnostic imaging
  • Heart Neoplasms* / pathology
  • Humans
  • Magnetic Resonance Imaging / methods
  • Magnetic Resonance Imaging, Cine / methods
  • Predictive Value of Tests
  • Retrospective Studies

Substances

  • Contrast Media
  • Gadolinium