Multimodality imaging to distinguish between benign and malignant cardiac masses

Ayaz Aghayev; Michael K Cheezum; Michael L Steigner; Negareh Mousavi; Robert Padera; Ana Barac; Raymond Y Kwong; Marcelo F Di Carli; Ron Blankstein

doi:10.1007/s12350-021-02790-9

Multimodality imaging to distinguish between benign and malignant cardiac masses

J Nucl Cardiol. 2022 Aug;29(4):1504-1517. doi: 10.1007/s12350-021-02790-9. Epub 2021 Sep 2.

Authors

Ayaz Aghayev¹, Michael K Cheezum², Michael L Steigner³, Negareh Mousavi⁴, Robert Padera⁵, Ana Barac⁶, Raymond Y Kwong⁷, Marcelo F Di Carli⁸, Ron Blankstein⁸

Affiliations

¹ Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. aaghayev@bwh.harvard.edu.
² Department of Cardiology, Parkview Health, Fort Wayne, IN, USA.
³ Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Cardiovascular Division, McGill University Health Center, Montreal, QC, Canada.
⁵ Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
⁶ MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA.
⁷ Cardiovascular Imaging Program, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

PMID: 34476778
DOI: 10.1007/s12350-021-02790-9

Abstract
in English, Chinese, Spanish

Background: To compare the diagnostic accuracy of CMR and FDG-PET/CT and their complementary role to distinguish benign vs malignant cardiac masses.

Methods: Retrospectively assessed patients with cardiac mass who underwent CMR and FDG-PET/CT within a month between 2003 and 2018.

Results: 72 patients who had CMR and FDG-PET/CT were included. 25 patients (35%) were diagnosed with benign and 47 (65%) were diagnosed with malignant masses. 56 patients had histological correlation: 9 benign and 47 malignant masses. CMR and FDG-PET/CT had a high accuracy in differentiating benign vs malignant masses, with the presence of CMR features demonstrating a higher sensitivity (98%), while FDG uptake with SUVmax/blood pool ≥ 3.0 demonstrating a high specificity (88%). Combining multiple (> 4) CMR features and FDG uptake (SUVmax/blood pool ratio ≥ 3.0) yielded a sensitivity of 85% and specificity of 88% to diagnose malignant masses. Over a mean follow-up of 2.6 years (IQR 0.3-3.8 years), risk-adjusted mortality were highest among patients with an infiltrative border on CMR (adjusted HR 3.1; 95% CI 1.5-6.5; P = .002) or focal extracardiac FDG uptake (adjusted HR 3.8; 95% CI 1.9-7.7; P < .001).

Conclusion: Although CMR and FDG-PET/CT can independently diagnose benign and malignant masses, the combination of these modalities provides complementary value in select cases.

背景: 本研究旨在比较心脏磁共振 (CMR) 和FDG-PET/CT的诊断准确性及其在鉴别心脏良恶性肿瘤中的互补作用。方法: 本研究回顾性地纳入了2003-2018年间在本中心被诊断为心脏肿瘤的患者, 所有患者CMR和FDG-PET/CT检查均在一个月内完成。结果: 本研究纳入了72例同时接受了CMR和FDG-PET/CT检查的患者。其中25例 (35%) 患者被诊断为心脏良性肿瘤, 47例 (65%) 患者被诊断为心脏恶性肿瘤。在所有72例患者中, 56例 (9例良性和47例恶性) 有组织学诊断的证据。CMR和FDG-PET/CT在鉴别心脏良性和恶性肿瘤方面具有较高的准确性。其中CMR的特点表现为较高的敏感性 (98%), 而当FDG摄取为SUVmax/血池≥ 3.0时, FDG-PET/CT有较高的特异性 (88%)。结合多种CMR特征 (> 4种) 和FDG摄取程度 (SUVmax/血池比率≥ 3.0) 用于心脏恶性肿瘤的诊断时, 其敏感性为85%, 特异性为88%。平均随访2.6年后 (IQR:0.3-3.8年), CMR表现为边界浸润 (调整后HR=3.1; 95%可信区间: 1.5-6.5; p=0.002) 或局灶性心脏外FDG摄取 (校正HR=3.8; 95%可信区间: 1.9-7.7; p<0.001) 的患者, 风险校正后的死亡率最高。结论: 尽管CMR和FDG-PET/CT可以独立地用于诊断心脏良性和恶性肿瘤, 但在某些特定病例中, 将这两种方法结合具有互补的诊断价值。.

Antecedentes: Comparar la precisión diagnóstica de la RMC y del PET/CT con FDG y su función complementaria para distinguir entre masas cardíacas benignas y malignas. MéTODOS: Pacientes evaluados retrospectivamente con masas cardíacasque se sometieron a RMC y a PET/CT con FDG en un periodo de 1 mes entre 2003-2018.

Resultados: Se incluyeron 72 pacientes a los que se les realizó RMC y PET/CT con FDG. 25 pacientes (35%) fueron diagnosticados como masas benignas y 47 (65%) como masas malignas. 56 pacientes tuvieron correlación histológica: 9 masas benignas y 47 malignas.La RMC y el PET/CT con FDG tuvieron una alta precisión en la diferenciación de masas benignas de malignas, algunas caracteristicas de la RMC demostraron una mayor sensibilidad (98 %), mientras que una captación de FDG (SUVmax/poolsanguíneo ≥ 3.0)demostró una alta especificidad (88%). Combinando múltiples (>4) características de la RMC con la captación de FDG (SUVmax/poolsanguíneo ≥ 3,0)se obtuvo una sensibilidad del 85% y una especificidad del 88 % para diagnosticar masas malignas. Durante un seguimiento promedio de 2.6 años (ICR: 0.3-3.8 años), la mortalidad ajustada por riesgo fue más alta entre los pacientes con un borde infiltrante en la RMC (HR ajustado = 3.1; IC del 95 %: 1.5-6.5;p=0.002) o captación extracardiaca focal de FDG (HR ajustado=3.8; IC 95%: 1.9-7.7; p<0.001). CONCLUSIóN: Aunque la RMC y el PET/CT con FDG pueden diagnosticar de forma independiente masas benignas y malignas, la combinación de estas modalidades proporciona un valor complementario en casos seleccionados.

Keywords: MRI; PET; modalities.

MeSH terms

Fluorodeoxyglucose F18*
Humans
Multimodal Imaging
Positron Emission Tomography Computed Tomography*
Positron-Emission Tomography / methods
Radiopharmaceuticals
Retrospective Studies
Tomography, X-Ray Computed / methods

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18

Abstract in English, Chinese, Spanish

MeSH terms

Substances

Abstract
in English, Chinese, Spanish