الفهرس 
Anatomy and Orientation of the HeartOnly 14 pages are availabe for public view
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Abstract
Cardiac tumors, either benign or malignant, are rare. Malignant tumors have a poorer prognosis than benign tumors; however both are associated with significant morbidity in cases of delayed management. So the correct identification and differentiation between the cardiac masses are essential for better therapeutic planning and better prognosis.
Definite diagnosis of cardiac masses is done by biopsy and histopathology; however, the invasiveness of cardiac biopsy may lead to multiple complications up to cardiac tamponade and death, also, most cardiac masses are not amenable to percutaneous or catheter biopsy. Here it comes the crucial role of cardiac imaging in evaluation of cardiac masses.
Multiple imaging modalities including echocardiography, MDCT and CMR, are used in evaluation and characterization of cardiac masses. Echocardiography is the primary imaging modality; however, in most of cases it is unable to reach final diagnosis owing to incomplete cardiac evaluation due to limited field of view and soft tissue resolution as well as inadequate evaluation of extracardiac structures.
Cardiac MRI has gained more acceptance to evaluate suspected cardiac tumors owing to its non-invasive nature and lack of ionizing radiation exposure as well as its high temporal resolution providing better tissue characterization. So, CMR is considered nowadays the gold standard in assessment of suspected cardiac tumor.
We conducted a study to elucidate the role of multi-parametric CMR for better characterization of cardiac masses. Our diagnosis was made depending on the MR features as described in literatures as well as the clinical data and follow up. We aimed to differentiate between true and pseudo tumors as well as benign and malignant lesions so as to reach an accurate diagnosis that was accepted clinically and fulfilled the data needed for pre-therapeutic planning without need of the unnecessary invasive biopsy.
In our study, two radiologists interpreted and analyzed separately the imaging data of 27 patients who met the inclusion criteria and performed CMR at MRI unit in Ain Shams University Educational Hospital and Misr Radiology center in Cairo. Only the agreed diagnosis of both radiologists was considered in our study. The remaining was two cases that either showed disagreement between the radiologists’ final diagnoses or both radiologists failed to give the final diagnosis and needed further investigation.
Thrombus is considered the most common non neoplastic cardiac mass (pseudo-tumor). Pseudo-tumors are characterized by their regular marginal outline and the absence of enhancement in delayed post contrast study as well as their preferential location in the right atrium and least affection in the right ventricle.
The most common benign tumor in adult is myxoma and in children is rhabdomyoma. The benign cardiac masses are characterized by their relative small size, regular marginal outline, localized pattern of growth, and absence of pericardial infiltration while malignant masses are characterized by their relative large size, irregular marginal outline, variable enhancement in delayed post contrast study, diffuse infiltrative pattern of growth, presence of pericardial infiltration and / or pericardial effusion, infiltration of the great vessels as IVC as well as presence of extra cardiac masses.
CMR has not only the ability to differentiate between benign and malignant lesions but also has the ability to differentiate between different types of benign tumors in most of cases by determination the location of the cardiac mass, its mobility, presence of pedicles and the variable MR signal intensity in different pre and post contrast sequences. In contrast to the malignant lesions, CMR shows a difficulty in the differentiation between different types of malignant lesions and usually needs histopathological correlation. However CMR shows a great value in determining the extent of the malignant lesions that is needed before planning the therapeutic management.
Some promising techniques such as DWI, DTI and MRS in cardiac imaging are expected to add more valuable information helping in better characterization of cardiac masses, and their role should be verified in future researches.