Palaskas Nicolas, Thompson Kara, Gladish Gregory, Agha Ali M, Hassan Saamir, Iliescu Cezar, Kim Peter, Durand Jean B, Lopez-Mattei Juan C
Department of Cardiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1451, Houston, TX, 77030, USA.
Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Curr Treat Options Cardiovasc Med. 2018 Mar 20;20(4):29. doi: 10.1007/s11936-018-0625-z.
Our purpose is to discuss the importance of multimodality imaging in the assessment of cardiac tumors and management. We have compiled a recent review of the scientific literature and embedded our clinical pathways and recommendations based on data and clinical experience.
The use of contrast echocardiography in the assessment of cardiac masses has been shown to be helpful in distinguishing tumor from thrombus. Deformation imaging of cardiac tumors has been shown to differentiate better rhabdomyomas from fibromas in pediatric patients. Cardiac MRI (CMR) appears to be helpful in determining whether cardiac tumors are benign or malignant by identifying presence of infiltration, uptake of contrast in first pass perfusion and gadolinium enhancement. Patients with evidence of cardiac metastases by CMR show similar survival to stage IV cancer without cardiac metastases. In our institution, we use a standardized approach for the evaluation of cardiac masses, which includes multimodality imaging in the appropriate clinical context. The autotransplantation surgical technique has shown some promise in improving survival in patients with primary cardiac sarcomas. In our institution, we do not routinely recommend anticoagulation for "tumor-thrombus" in renal cell carcinoma due to risk of bleeding from primary tumor. Cardiac masses are often found incidentally, but sometimes can present with cardiovascular symptoms due to obstruction and valvular dysfunction, which may prompt imaging. It is important to determine whether the mass is a normal variant, imaging artifact, vegetation, thrombus, or tumor. Transthoracic echocardiography is ideally suited to be the initial imaging modality because of the portability, wide availability, lack of radiation, and relatively low cost. The gold standard cardiac imaging technique to distinguish tumor from thrombus is contrast enhanced CMR with prolonged inversion time. Advantages of CMR when compared to echocardiography regarding characterization of cardiac tumors are as follows: larger field of view, better spatial resolution, better tissue characterization, lack of attenuation, and ability to image at any prescribed plane. Primary and secondary cardiac tumors have particular characteristics in echocardiography and CMR. Imaging of cardiac tumors plays an important role in establishing a diagnosis and in planning management.
我们旨在探讨多模态成像在心脏肿瘤评估及管理中的重要性。我们汇总了近期的科学文献综述，并依据数据和临床经验纳入了我们的临床路径及建议。
在心脏肿块评估中，使用对比超声心动图有助于区分肿瘤与血栓。在儿科患者中，心脏肿瘤的形变成像已显示出能更好地区分横纹肌瘤与纤维瘤。心脏磁共振成像（CMR）似乎有助于通过识别浸润情况、首过灌注时对比剂摄取及钆增强来确定心脏肿瘤是良性还是恶性。CMR显示有心脏转移证据的患者与无心脏转移的IV期癌症患者生存率相似。在我们机构，我们采用标准化方法评估心脏肿块，包括在适当临床背景下进行多模态成像。自体移植手术技术在改善原发性心脏肉瘤患者生存率方面已显示出一定前景。在我们机构，由于原发性肿瘤出血风险，对于肾细胞癌中的“肿瘤 - 血栓”，我们通常不建议常规抗凝。心脏肿块常为偶然发现，但有时因梗阻和瓣膜功能障碍出现心血管症状，这可能促使进行成像检查。确定肿块是正常变异、成像伪影、赘生物、血栓还是肿瘤很重要。经胸超声心动图因其便携性、广泛可用性、无辐射及成本相对较低，非常适合作为初始成像方式。区分肿瘤与血栓的金标准心脏成像技术是延长反转时间的对比增强CMR。与超声心动图相比，CMR在心脏肿瘤特征描述方面的优势如下：视野更大、空间分辨率更高、组织特征描述更好、无衰减以及能够在任何规定平面成像。原发性和继发性心脏肿瘤在超声心动图和CMR中有特定特征。心脏肿瘤成像在确立诊断和规划管理中起着重要作用。
