Huang Wen-Peng, Gao Ge, Chen Zhao, Qiu Yong-Kang, Gao Jian-Bo, Kang Lei
Department of Nuclear Medicine, Peking University First Hospital, Beijing, China.
Department of Radiology, Peking University First Hospital, Beijing, China.
Front Med (Lausanne). 2022 Jun 30;9:942558. doi: 10.3389/fmed.2022.942558. eCollection 2022.
Cardiac paraganglioma (CPGL) accounts for 1-3% of cardiac tumors and is usually benign. In total, 35-50% of CPGL lesions secrete catecholamines, causing hypertension, excessive sweating, palpitations, headache, and other symptoms. Preoperative imaging evaluation is important to determine the location of the cardiac mass, its blood supply vessels, and the relationship with surrounding structures. Multimodal imaging techniques combine with morphological and functional information to provide powerful methods for preoperative diagnosis and lesion localization. Furthermore, they can assist to reduce the incidence of intraoperative and postoperative complications and improve patient prognosis.
A 67-year-old woman suffered from paroxysmal palpitations with a heart rate of 110 beats per minute 1 month ago. Urine catecholamine and methoxyepinephrine levels were significantly increased. The patient had a 5-year history of hypertension with a maximum blood pressure of 160/100 mmHg. Computed tomography (CT) examination found a soft tissue mass in the right atrium with heterogeneous and significant enhancement, whose blood supply was from the left ileal branch artery. The patient then underwent cardiac magnetic resonance (CMR). The lesion showed inhomogeneous iso signals on the T1-weighted image (T1WI), slightly high signals on the T2 fat-suppression image, inhomogeneous high signals on the diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) images. The mass exhibited heterogeneous and significant enhancement on the first perfusion and delayed scans after intravenous contrast injection. However, abnormal signals were surprisingly found in the patient's right lung, and the possibility of metastatic lesions could not be excluded. The patient underwent F-18 fluorodeoxyglucose-positron emission tomography/computed tomography (F-FDG PET/CT) to rule out metastatic lesions. A fluorodeoxyglucose (FDG)-avid soft tissue mass was shown in the right atrium, with the maximum standardized uptake value (SUVmax) at about 15.2, as well as a pathological intake of brown fat throughout the body. Combined with clinical symptoms, CPGL was considered without significant sign of metastasis in F-FDG PET/CT. Finally, the patient underwent surgical resection and the post-operative pathology confirmed a CPGL.
The combination of F-FDG PET/CT with the CMR containing different image acquisition sequences provides a powerful aid for preoperative non-invasive diagnosis, localization, and staging of CPGL, which helps to reduce intraoperative and postoperative complications and improve patient prognosis.
心脏副神经节瘤（CPGL）占心脏肿瘤的1% - 3%，通常为良性。总体而言，35% - 50%的CPGL病变分泌儿茶酚胺，导致高血压、多汗、心悸、头痛及其他症状。术前影像学评估对于确定心脏肿物的位置、其供血血管以及与周围结构的关系至关重要。多模态成像技术结合形态学和功能信息，为术前诊断和病变定位提供了有力方法。此外，它们有助于降低术中及术后并发症的发生率，改善患者预后。
一名67岁女性1个月前出现阵发性心悸，心率每分钟110次。尿儿茶酚胺和甲氧基肾上腺素水平显著升高。该患者有5年高血压病史，最高血压为160/100 mmHg。计算机断层扫描（CT）检查发现右心房有一软组织肿物，密度不均匀且强化明显，其血供来自左髂支动脉。患者随后接受了心脏磁共振成像（CMR）检查。该病变在T1加权像（T1WI）上呈不均匀等信号，在T2脂肪抑制像上呈稍高信号，在扩散加权成像（DWI）及表观扩散系数（ADC）图像上呈不均匀高信号。静脉注射对比剂后首次灌注及延迟扫描显示肿物强化不均匀且明显。然而，令人惊讶的是在患者右肺发现异常信号，不能排除转移瘤的可能性。患者接受了F - 18氟脱氧葡萄糖 - 正电子发射断层扫描/计算机断层扫描（F - FDG PET/CT）以排除转移瘤。F - FDG PET/CT显示右心房有一摄取氟脱氧葡萄糖（FDG）的软组织肿物，最大标准化摄取值（SUVmax）约为15.2，全身棕色脂肪有生理性摄取。结合临床症状，F - FDG PET/CT考虑为无明显转移征象的CPGL。最后，患者接受了手术切除，术后病理证实为CPGL。
F - FDG PET/CT与包含不同图像采集序列的CMR相结合，为CPGL的术前无创诊断、定位及分期提供了有力帮助，有助于减少术中及术后并发症，改善患者预后。
