Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours
Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours
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DOI：
10.1093/eurheartj/ehr104
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发表时间：
2011-06-01
影响因子：
39.3
通讯作者：
Buser, Peter T.
中科院分区：
文献类型：
--
作者：
Fussen, Sandra;De Boeck, Bart W. L.;Buser, Peter T.
目的 从风险分层和治疗管理的角度评估心血管磁共振 (CMR) 成像对疑似心脏肿瘤患者的诊断准确性。 方法和结果 对转诊评估疑似心脏肿块的 41 名连续患者（年龄 61 +/- 14 岁，21 名男性）进行心血管磁共振检查，以了解各种未增强和对比增强序列中的肿瘤形态和信号特征。将心血管磁共振诊断和治疗与接受手术或尸检的患者的临床结果和组织学进行比较（n = 20）。在 41 名患者中，有 18 名患者的 CMR 排除了肿块或将其重新分类为正常变异；所有人都接受保守治疗。在 41 名患者中，CMR 诊断出 23 名肿瘤（14 名“良性”、8 名“恶性”和 1 名“可疑”）；其中 18 名患者接受了手术，2 名患者接受保守治疗，3 名患者接受姑息治疗。在 705 天（四分位间距 303-1472）天的随访期间，13 名患者死亡。保守治疗的患者中没有发生与肿瘤相关的死亡。采用基于 CMR 的良性肿瘤诊断和治疗的患者与未检测到肿瘤的患者的生存率相似。与组织学相比，CMR 在 95% 的病例中正确地将肿块分类为“良性或恶性”。肿瘤灌注、侵袭性、定位和心包液对于区分恶性和良性肿瘤很有价值。不同序列中的软组织对比度和信号强度模式对于排除肿瘤病变很有价值，并有助于在选定的肿瘤病例中分别获得组织学水平的组织特征。 结论 综合 CMR 为疑似肿瘤患者提供了可靠的风险分层和临床管理工具。 CMR 排除肿瘤的患者可以进行保守治疗。
Aims To evaluate the diagnostic accuracy of cardiovascular magnetic resonance (CMR) imaging from a risk-stratification and therapeutic-management perspective in patients with suspected cardiac tumours.Methods and results Cardiovascular magnetic resonance exams of 41 consecutive patients (aged 61 +/- 14 years, 21 men) referred for evaluation of a suspected cardiac mass were reviewed for tumour morphology and signal characteristics in various unenhanced and contrast-enhanced sequences. Cardiovascular magnetic resonance-derived diagnosis and treatment were compared with clinical outcome and histology in patients undergoing surgery or autopsy (n = 20). In 18 of 41 patients, CMR excluded masses or reclassified them as normal variants; all were treated conservatively. In 23 of 41 patients, CMR diagnosed a neoplasm (14 'benign', 8 'malignant', and 1 'equivocal'); 18 of these patients were operated on, 2 managed conservatively, and 3 by palliation. During follow-up of 705 (inter-quartile range 303-1472) days, 13 patients died. No tumour-related deaths occurred in conservatively managed patients. Patients with a CMR-based diagnosis and treatment of benign tumour had a similar survival as patients without detectable tumour. Compared with histology, CMR correctly classified masses as 'benign or malignant' in 95% of the cases. Tumour perfusion, invasiveness, localization, and pericardial fluid were valuable to distinguish between malignant and benign tumours. Soft tissue contrast and signal intensity patterns in various sequences were valuable for excluding neoplastic lesions and helped to obtain tissue characterization at the histological level in selected tumour cases, respectively.Conclusion Comprehensive CMR provides a confident risk-stratification and clinical-management tool in patients with suspected tumours. Patients where CMR excludes tumours can be managed conservatively.