Li Ying, Ren Weidong, Wang Xin, Xiao Yangjie, Feng Yueqin, Shi Pengli, Sun Lijuan, Wang Xiao, Yang Huan, Song Guang
Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China.
Front Cardiovasc Med. 2022 Sep 16;9:1011560. doi: 10.3389/fcvm.2022.1011560. eCollection 2022.
To evaluate the diagnostic accuracy of contrast echocardiography (CE) in patients with suspected cardiac masses.
A multicenter, prospective study involving 108 consecutive patients with suspected cardiac masses based on transthoracic echocardiography performed between November 2019 and December 2020 was carried out. CE examinations were performed in all patients. The echocardiographic diagnosis was established according to the qualitative (echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility) and quantitative (area of the masses and peak intensity ratio of the masses and adjacent myocardium A1/A2) evaluations.
Final confirmed diagnoses were as follows: no cardiac mass ( = 3), pseudomass ( = 3), thrombus ( = 36), benign tumor ( = 30), and malignant tumor ( = 36). ROC analysis revealed the optimal A1/A2 with cutoff value of 0.295 for a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.958 (95% confidence interval (CI): 0.899-0.988), 100, 91.7, 95.7, and 100%, respectively. CE was able to distinguish malignant from benign tumors with an AUC of 0.953 (95% CI: 0.870-0.990). Multivariate logistic regression analysis revealed that tumor area, base, and A1/A2 were associated with the risk of malignant tumor (OR = 1.003, 95% CI: 1.00003-1.005; OR = 22.64, 95% CI: 1.30-395.21; OR = 165.39, 95% CI: 4.68-5,850.94, respectively). When using A1/A2 > 1.28 as the only diagnostic criterion to identify the malignant tumor, AUC, sensitivity, specificity, PPV, and NPV were 0.886 (95% CI: 0.784-0.951), 80.6, 96.7, 96.7, and 80.7%, respectively.
CE has the potential to accurately differentiate cardiac masses by combining qualitative and quantitative analyses. However, more studies with a large sample size should be conducted to further confirm these findings.
http://www.chictr.org.cn/, identifier: ChiCTR1900026809.
评估对比增强超声心动图（CE）对疑似心脏肿物患者的诊断准确性。
开展一项多中心前瞻性研究，纳入2019年11月至2020年12月期间经胸超声心动图检查发现的108例连续的疑似心脏肿物患者。所有患者均接受CE检查。根据定性（回声性、边界、基部形态、肿物灌注、心包积液及活动度）和定量（肿物面积以及肿物与相邻心肌的峰值强度比A1/A2）评估确立超声心动图诊断。
最终确诊如下：无心脏肿物（n = 3）、假肿物（n = 3）、血栓（n = 36）、良性肿瘤（n = 30）及恶性肿瘤（n = 36）。ROC分析显示，鉴别心脏肿瘤与血栓的最佳A1/A2截断值为0.295，曲线下面积（AUC）、灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）分别为0.958（95%置信区间（CI）：0.899 - 0.988）、100%、91.7%、95.7%和100%。CE鉴别恶性与良性肿瘤的AUC为0.953（95% CI：0.870 - 0.990）。多因素逻辑回归分析显示，肿瘤面积、基部及A1/A2与恶性肿瘤风险相关（比值比（OR）分别为1.003，95% CI：1.00003 - 1.005；OR = 22.64，95% CI：1.30 - 395.21；OR = 165.39，95% CI：4.68 - 5850.94）。以A1/A2 > 1.28作为鉴别恶性肿瘤的唯一诊断标准时，AUC、灵敏度、特异度、PPV和NPV分别为0.886（95% CI：0.784 - 0.951）、80.6%、96.7%、96.7%和80.7%。
CE通过定性和定量分析相结合有潜力准确鉴别心脏肿物。然而应开展更多大样本研究以进一步证实这些发现。
