Cardiac Masses

Cardiac MRI is an important imaging tool for accurate diagnosis and management of cardiac neoplasms.reference  Cardiac MR can enable confident differentiation between benign and malignant tumors.reference

Aetna Policy 0520 (CMR) identifies “external or internal [cardiac] masses, pathology of lung and pleura” as indications of medical necessity for CMR.  Similarly, Cigna Policy 0168 (CMR) cites “cardiac tumor or thrombus ” as an indication of medical necessity for CMR.

“Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.”reference

Cine MR allows dynamic assessment of cardiac masses as well as their effect on valvular function. MR can demonstrate key indicators of malignancy including invasive behavior, involvement of the right side of the heart or the pericardium, tissue inhomogeneity, diameter greater than 5 cm, and higher tissue vascularity.reference CMR also visualizes characteristics which distinguish cardiac masses from intracardiac thrombus, normal anatomic variants, and normal myocardium.

MR imaging offers improved resolution, a larger field of view, and superior soft-tissue contrast compared with other modalities used in the evaluation of cardiac masses.reference

References:

Sparrow P, Kurian JB,  Jones TR, Sivananthan MU. MR Imaging of Cardiac Tumors.  RadioGraphics. 2005.

O’Donnell D, Abbara S, Chaithiraphan V, Yared K, Killeen RP, Cury RC, Dodd JD. Cardiac Tumors: Optimal Cardiac MR Sequences and Spectrum of Imaging Appearances.  American Journal of Roentgenology. 2009.

Narin B, Arman A, Arslan D, Simşek M, Narin A. Assessment of cardiac masses: magnetic resonance imaging versus transthoracic echocardiography.  Anatolian Journal of Cardiology. 2010.

 

CMRI showing cardiac sarcoid.

CMRI showing Cardiac Sarcoid. (click for larger image)

Cardiac Mass via cardiac MRI. (click for larger image)