Prognostic utility of differential tissue characterization of cardiac neoplasm and thrombus via late gadolinium enhancement cardiovascular magnetic resonance among patients with advanced systemic cancer
Prognostic utility of differential tissue characterization of cardiac neoplasm and thrombus via late gadolinium enhancement cardiovascular magnetic resonance among patients with advanced systemic cancer
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DOI：
10.1186/s12968-017-0390-2
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发表时间：
2017-10-12
影响因子：
6.4
通讯作者：
Weinsaft, Jonathan W.
中科院分区：
文献类型：
--
作者：
Chan, Angel T.;Plodkowski, Andrew J.;Weinsaft, Jonathan W.
背景：晚期Gd增强(LGE-)心血管磁共振(CMR)对于区分肿瘤(C-neo)和血栓(C-Thr)的心脏肿块(C-MASS)的组织特征是有效的：C-MASS亚型在系统性癌症患者中的预后意义尚不清楚。方法：与癌症诊断和分期匹配的C-MASS患者和对照(C-MASS)接受标准化的CMR方案，包括用于组织表征的LGE-CMR(IR-GRE)和用于心脏结构/功能的平衡稳态自由进动电影CMR(SSFP)。C质量亚型(C-neo，C-Thr)分别根据LGE-CMR上有无强化来定义；病变的组织属性(对比噪声比(CNR)、信噪比(SNR)和大小)被量化。结果：研究对象为126例全身肿瘤患者，其中C-MASS阳性者占50%(n=63)(C-neo=32%，C-Thr=18%)。癌症病因在C-neo(肉瘤=20%，肺=18%)和C-Thr(淋巴瘤=30%，胃肠道=26%)之间存在差异；心功能(左心室射血分数：63+/-9比62+/-10%；p=0.51|右室射血分数：53+/-9比54+/-8%；p=0.47)和几何指标相似(均为p=NS)。对于C-NEO，用CNR(13.1+/-13.0vs.1.6+/-1.0；p<；0.001)和SNR(29.7+/-20.4vs.15.0+/-11.4，p=0.003)评估的LGE-CMR组织特性更高，与视觉分配的诊断类别一致。C-Thr更有可能位于右心房(78%vs.25%，p<；0.001)；几乎所有(17/18)患者都与中心导管有关。与C-Thr相比，C-neo的病变范围(17.3+/-23.8vs.2.0+/-1.5 cm(2)；p<；0.001)更大，全身疾病负担也更大(涉及癌症的器官：3.6vs.2.3+/-2.1vs.2.3+/-2.1.p=0.02)。C-neo患者2.5年的中位随访期死亡率明显高于C-Thr患者(HR=3.13[CI 1.54-6.39]，p=0.002)；根据面积(HR=0.99/cm[CI 0.98-1.01]，P=0.40)或最大直径(HR=0.98/cm[CI 0.91-1.06]，P=0.61)对患者进行分级，预后相似。与没有心脏受累的癌症匹配对照组相比，C-Thr具有相似的死亡风险(p=0.64)，而与C-neo相关的死亡率略高，但无统计学意义(p=0.12)。结论：在有心脏肿块的广泛癌症队列中，由LGE-CMR组织特征定义的C-neo的预后明显比C-Thr差，而通过Cine-CMR进行的解剖学评估并不能对死亡风险进行分层。与与癌症类型和疾病程度相匹配的C质量对照组相比，C-neo和C-Thr与预后相似。
Background: Late gadolinium enhancement (LGE-) cardiovascular magnetic resonance (CMR) is well-validated for cardiac mass (C-MASS) tissue characterization to differentiate neoplasm (C-NEO) from thrombus (C-THR): Prognostic implications of C-MASS subtypes among systemic cancer patients are unknown.Methods: C-MASS + patients and controls (C-MASS -) matched for cancer diagnosis and stage underwent a standardized CMR protocol, including LGE-CMR (IR-GRE) for tissue characterization and balanced steady state free precession cine-CMR (SSFP) for cardiac structure/function. C-MASS subtypes (C-NEO, C-THR) were respectively defined by presence or absence of enhancement on LGE-CMR; lesions were quantified for tissue properties (contrast-to-noise ratio (CNR); signal-to-noise ratio (SNR) and size. Clinical follow-up was performed to evaluate prognosis in relation to C-MASS etiology.Results: The study population comprised 126 patients with systemic neoplasms referred for CMR, of whom 50% (n = 63) had C-MASS + (C-NEO = 32%, C-THR = 18%). Cancer etiology differed between C-NEO (sarcoma = 20%, lung = 18%) and C-THR (lymphoma = 30%, GI = 26%); cardiac function (left ventricular ejection fraction: 63 +/- 9 vs. 62 +/- 10%; p = 0.51| right ventricular ejection fraction: 53 +/- 9 vs. 54 +/- 8%; p = 0.47) and geometric indices were similar (all p = NS). LGE-CMR tissue properties assessed by CNR (13.1 +/- 13.0 vs. 1.6 +/- 1.0; p < 0.001) and SNR (29.7 +/- 20.4 vs. 15.0 +/- 11.4, p = 0.003) were higher for C-NEO, consistent with visually-assigned diagnostic categories. C-THR were more likely to localize to the right atrium (78% vs. 25%, p < 0.001); nearly all (17/18) were associated with central catheters. Lesion size (17.3 +/- 23.8 vs. 2.0 +/- 1.5 cm(2); p < 0.001) was greater with C-NEO vs. C-THR, as was systemic disease burden (cancer-involved organs: 3.6 +/- 2.0 vs. 2.3 +/- 2.1; p = 0.02). Mortality during a median follow-up of 2.5 years was markedly higher among patients with C-NEO compared to those with C-THR (HR = 3.13 [CI 1.54-6.39], p = 0.002); prognosis was similar when patients were stratified by lesion size assessed via area (HR = 0.99 per cm2 [CI 0.98-1.01], p = 0.40) or maximal diameter (HR = 0.98 per cm [CI 0.91-1.06], p = 0.61). C-THR conferred similar mortality risk compared to cancer-matched controls without cardiac involvement (p = 0.64) whereas mortality associated with C-NEO was slightly higher albeit non-significant (p = 0.12).Conclusions: Among a broad cancer cohort with cardiac masses, C-NEO defined by LGE-CMR tissue characterization conferred markedly poorer prognosis than C-THR, whereas anatomic assessment via cine-CMR did not stratify mortality risk. Both C-NEO and C-THR are associated with similar prognosis compared to C-MASS - controls matched for cancer type and disease extent.