Cardiac masses: assessment by MR imaging

Our plain-English summary of Cardiac masses: assessment by MR imaging, by J.T. Lund, R.L. Ehman, P.R. Julsrud, et al (AJR. American Journal of Roentgenology, 1989).

The study

• Authors: J.T. Lund, R.L. Ehman, P.R. Julsrud, L.J. Sinak, A.J. Tajik
• Journal: AJR. American Journal of Roentgenology
• Published: 1989;152(3):469-73
• Cited by: 142 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The purpose of this study was to assess the role of MR imaging for evaluating suspected cardiac tumors or paracardiac masses involving the heart. Sixty-one patients with clinical or radiologic evidence of cardiac masses were imaged with ECG-gated MR at 1.5 T (22 patients) or 0.15 T (39 patients). Fifty-one patients had echocardiography previously. Among the tissue diagnoses were myxoma (six); fibroma, rhabdomyoma, plasma cell granuloma, lipomatous hypertrophy of the atrial septum, mesothelioma, and thymoma (two each); and leiomyosarcoma, lymphoma, metastatic carcinoid, melanoma, malignant fibrous histiocytoma, hemangiopericytoma, and lung spindle cell sarcoma (one each). MR imaging demonstrated masses in 50 patients (82%); they were centered in the heart in 32, pericardial in nine, and juxtacardiac in nine. MR imaging provided diagnostic information that affected clinical management or surgical planning in 53 patients (87%), including 11 (18%) in whom cardiac mass was excluded by MR. The ability to provide a global view of cardiac anatomy and other unique capabilities of MR imaging give the procedure an important role in the diagnosis and preoperative assessment of cardiac masses.

In plain English

This study, from the Mayo Clinic, looked at how useful magnetic resonance (MR) imaging was for patients thought to have tumors or other masses in or next to the heart. It did not study asbestos. Some patients had mesothelioma of the pericardium, the sac around the heart. Between 1983 and 1987, 61 patients aged 3 months to 82 years had heart MR scans. MR showed no mass in 11 patients (18%) and showed a mass in 50 (82%): 32 in the heart muscle or chambers, nine in the pericardium and nine next to the heart. Seven of the nine pericardial lesions were malignant, including pericardial mesothelioma. In one patient, MR showed that a pericardial mesothelioma that had spread to the liver could not be removed by surgery. MR findings affected management or surgical planning in 53 patients (87%). The authors noted that clots on the heart wall were hard to tell apart from blood-flow artifacts. The authors concluded that echocardiography would remain the main test, with MR playing a complementary role.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series reviewing MR imaging results and patient records for people with suspected cardiac masses (diagnostic imaging study)
• Who was studied: 61 patients (32 male, 29 female, aged 3 months to 82 years, mean 51) with suspected cardiac masses seen at the Mayo Clinic between September 1983 and May 1987
• Exposure: No asbestos or other environmental or occupational exposure was studied. The study evaluated ECG-gated MR imaging of the heart.
• Main results:
  • 11 of the 61 patients (18%) had normal MR examinations.
  • MR showed a mass in 50 of the 61 patients (82%).
  • Of the nine pericardial lesions, two were benign (radiation-induced pericardial thickening) and seven were malignant, including pericardial mesothelioma.
  • In one patient with pericardial mesothelioma that had spread to the liver, MR showed the tumor was unresectable because of the extent of heart muscle involvement.
  • Pericardial involvement by tumor was correctly identified or excluded by MR in all 10 patients with surgical confirmation.
  • MR findings affected clinical management or surgical planning in 53 patients (87%), including the 11 (18%) in whom a cardiac mass was excluded.
• The authors' conclusion: The authors concluded that echocardiography would remain the primary technique for detecting cardiac masses, but that MR imaging can play a complementary role, especially in assessing patients with known masses before surgery.
• Limitations the authors state:
  • Mural thrombi (clots on the heart wall) were difficult to tell apart from blood-flow artifacts.
  • The scanning sequences used tend not to distinguish between different non-fatty soft tissues.
  • Most patients with normal MR examinations had no follow-up studies.

Topics

Medical terms in this study, explained in our Lexicon: Granuloma, Mesothelioma, Spindle Cell, Sarcoma, Pericardial.

Related studies

• Primary tumors and cysts of the heart and pericardium — H.A. McAllister (1979)
• Occult primary cardiac lymphomas causing unexpected/sudden death or acute heart failure — A. De Martino, F. Del Re, et al. (2020)
• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)
• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Renal, vascular and cardiac fibrosis in rats exposed to passive smoking and industrial dust fibre amosite — P. Boor, S. Casper, et al. (2009)
• Epidemiology of primary malignant mesothelial tumors in Canada — A.D. McDonald, A. Harper, et al. (1970)

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