Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex.
Piedmont Heart Institute, Atlanta, Ga.
J Thorac Cardiovasc Surg. 2019 May;157(5):1912-1922.e2. doi: 10.1016/j.jtcvs.2018.09.057. Epub 2018 Oct 6.
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.
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.
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.
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.
本分析旨在描述良性和恶性肿瘤在心脏磁共振特征上的差异，这有助于手术规划。
这是一项对 130 例疑似心脏肿块行心脏磁共振成像评估的患者进行的前瞻性队列研究。排除血栓和无明确诊断的肿瘤后，对 66 个肿瘤的形态特征和组织成分进行评估。
在 66 例患者中，39 例（59.0%）为恶性肿瘤，27 例（41.0%）为良性肿瘤。与良性肿瘤患者相比，恶性肿瘤患者年龄更小（年龄 51 岁[42.8-60.0]比 65 岁[60.0-71.0]中位数）。恶性肿瘤更常表现为肿瘤侵犯（69%比 0%，P < 0.001），更常伴有心包积液（41%比 7.4%，P = 0.004）。首过灌注（100%比 33%，P < 0.001）和晚期钆增强（100%比 59.2%，P < 0.001）在恶性肿瘤中显著更高。在逻辑回归模型中，肿瘤侵犯（P < 0.001）和首过灌注（P < 0.001）与恶性肿瘤独立相关。此外，我们使用分类回归树分析建立了一个决策树算法来帮助区分良性和恶性肿瘤（诊断准确性约为 90%）。将恶性肿瘤误诊为良性肿瘤的算法加权成本是将良性肿瘤误诊为恶性肿瘤的两倍。
我们的研究表明，心脏磁共振成像术是一种区分良恶性心脏肿瘤的有用的非侵入性方法。肿瘤大小、侵犯和首过灌注是区分良恶性肿瘤的有用的影像学特征。
