TY - JOUR
T1 - Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging
AU - Kassi, Mahwash
AU - Polsani, Venkateshwar
AU - Schutt, Robert C.
AU - Wong, Solomon
AU - Nabi, Faisal
AU - Reardon, Michael J.
AU - Shah, Dipan J.
N1 - Publisher Copyright:
© 2018 The American Association for Thoracic Surgery
PY - 2019/5
Y1 - 2019/5
N2 - Background: The purpose of this analysis is to describe the differences in cardiac magnetic resonance characteristics between benign and malignant tumors, which would be helpful for surgical planning. Methods: This was a prospective cohort study of 130 patients who underwent cardiac magnetic resonance imaging for evaluation of a suspected cardiac mass. After excluding thrombi and tumors without definitive diagnosis, 66 tumors were evaluated for morphologic features and tissue composition. Results: Of the 66 patients, 39 (59.0%) had malignant tumors and 27 (41.0%) had benign tumors. Patients with malignant tumors were younger when compared with those with benign tumors (age 51 years [42.8-60.0] vs 65 years [60.0-71.0] median). Malignant tumors more often demonstrated tumor invasion (69% vs 0% P <.001) and were more often associated with pericardial effusion (41% vs 7.4% P =.004). Presence of first-pass perfusion (100% vs 33% P <.001) and late gadolinium enhancement (100% vs 59.2%, P <.001) were significantly higher in malignant tumors. In logistic regression modeling, tumor invasion (P <.001) and first-pass perfusion (P <.001) were independently associated with malignancy. Furthermore, using classification and regression tree analysis, we developed a decision tree algorithm to help differentiate benign from malignant tumors (diagnostic accuracy ∼90%). The algorithm-weighted cost of misclassifying a malignant tumor as benign was twice that of classifying a benign tumor as malignant. Conclusions: Our study demonstrates that cardiac magnetic resonance imaging is a useful noninvasive method for differentiating malignant from benign cardiac tumors. Tumor size, invasion, and first-pass perfusion were useful imaging characteristics in differentiating benign from malignant tumors.
AB - Background: The purpose of this analysis is to describe the differences in cardiac magnetic resonance characteristics between benign and malignant tumors, which would be helpful for surgical planning. Methods: This was a prospective cohort study of 130 patients who underwent cardiac magnetic resonance imaging for evaluation of a suspected cardiac mass. After excluding thrombi and tumors without definitive diagnosis, 66 tumors were evaluated for morphologic features and tissue composition. Results: Of the 66 patients, 39 (59.0%) had malignant tumors and 27 (41.0%) had benign tumors. Patients with malignant tumors were younger when compared with those with benign tumors (age 51 years [42.8-60.0] vs 65 years [60.0-71.0] median). Malignant tumors more often demonstrated tumor invasion (69% vs 0% P <.001) and were more often associated with pericardial effusion (41% vs 7.4% P =.004). Presence of first-pass perfusion (100% vs 33% P <.001) and late gadolinium enhancement (100% vs 59.2%, P <.001) were significantly higher in malignant tumors. In logistic regression modeling, tumor invasion (P <.001) and first-pass perfusion (P <.001) were independently associated with malignancy. Furthermore, using classification and regression tree analysis, we developed a decision tree algorithm to help differentiate benign from malignant tumors (diagnostic accuracy ∼90%). The algorithm-weighted cost of misclassifying a malignant tumor as benign was twice that of classifying a benign tumor as malignant. Conclusions: Our study demonstrates that cardiac magnetic resonance imaging is a useful noninvasive method for differentiating malignant from benign cardiac tumors. Tumor size, invasion, and first-pass perfusion were useful imaging characteristics in differentiating benign from malignant tumors.
KW - cardiac magnetic resonance imaging
KW - cardiac tumors
KW - first-pass perfusion
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U2 - 10.1016/j.jtcvs.2018.09.057
DO - 10.1016/j.jtcvs.2018.09.057
M3 - Article
C2 - 30551963
AN - SCOPUS:85058057170
SN - 0022-5223
VL - 157
SP - 1912-1922.e2
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -