Haider Imran, Ullah Hameed, Fatima Mishaim, Karim Muhammad Sikandar, Haq Furqan Ul, Majid Abdul, Anwar Muhammad Saad, Nawaz Fatima Kausar, Ali Ijaz, Sarwar Atif Hussain, Anwar Muhammad Tayyab, Khan Abdul Wali, Humayun Omama, Alam Fazal
Radiology Department, Saint Luke's Hospital, Chesterfield, MO, United States.
Internal Medicine Department, Hayatabad Medical Complex (HMC), Peshawar, Khyber Pakhtunkhwa, Pakistan.
Front Cardiovasc Med. 2023 Jun 27;10:1009411. doi: 10.3389/fcvm.2023.1009411. eCollection 2023.
Generally, cardiac masses are initially suspected on routine echocardiography. Cardiac magnetic resonance (CMR) imaging is further performed to differentiate tumors from pseudo-tumors and to characterize the cardiac masses based on their appearance on T1/T2-weighted images, detection of perfusion and demonstration of gadolinium-based contrast agent uptake on early and late gadolinium enhancement images. Further evaluation of cardiac masses by CMR is critical because unnecessary surgery can be avoided by better tissue characterization. Different cardiac tissues have different T1 and T2 relaxation times, principally owing to different internal biochemical environments surrounding the protons. In CMR, the signal intensity from a particular tissue depends on its T1 and T2 relaxation times and its proton density. CMR uses this principle to differentiate between various tissue types by weighting images based on their T1 or T2 relaxation times. Generally, tumor cells are larger, edematous, and have associated inflammatory reactions. Higher free water content of the neoplastic cells and other changes in tissue composition lead to prolonged T1/T2 relaxation times and thus an inherent contrast between tumors and normal tissue exists. Overall, these biochemical changes create an environment where different cardiac masses produce different signal intensity on their T1- weighted and T2- weighted images that help to discriminate between them. In this review article, we have provided a detailed description of the core CMR imaging protocol for evaluation of cardiac masses. We have also discussed the basic features of benign cardiac tumors as well as the role of CMR in evaluation and further tissue characterization of these tumors.
一般来说，心脏肿物最初是在常规超声心动图检查时被怀疑的。进一步进行心脏磁共振（CMR）成像，以区分肿瘤与假性肿瘤，并根据其在T1/T2加权图像上的表现、灌注检测以及钆基对比剂在早期和晚期钆增强图像上的摄取情况来对心脏肿物进行特征描述。CMR对心脏肿物进行进一步评估至关重要，因为通过更好的组织特征描述可以避免不必要的手术。不同的心脏组织具有不同的T1和T2弛豫时间，主要是由于质子周围不同的内部生化环境。在CMR中，特定组织的信号强度取决于其T1和T2弛豫时间以及质子密度。CMR利用这一原理，通过基于T1或T2弛豫时间对图像进行加权来区分各种组织类型。一般来说，肿瘤细胞更大、有水肿且伴有炎症反应。肿瘤细胞较高的自由水含量以及组织成分的其他变化导致T1/T2弛豫时间延长，因此肿瘤与正常组织之间存在固有的对比度。总体而言，这些生化变化创造了一种环境，不同的心脏肿物在其T1加权和T2加权图像上产生不同的信号强度，这有助于对它们进行区分。在这篇综述文章中，我们详细描述了用于评估心脏肿物的核心CMR成像方案。我们还讨论了良性心脏肿瘤的基本特征以及CMR在这些肿瘤评估和进一步组织特征描述中的作用。
