MR Imaging of Cardiac Tumors

Published Online:https://doi.org/10.1148/rg.255045721

Magnetic resonance (MR) imaging is an important tool in the evaluation of cardiac neoplasms. T1-weighted, T2-weighted, and gadolinium-enhanced sequences are used for anatomic definition and tissue characterization, whereas cine gradient-echo imaging is used to assess functional effects. Recent improvements in pulse sequences for cardiac MR imaging have led to superior image quality, with reduced motion artifact and improved signal-to-noise ratio and tissue contrast. Although there is some overlap in the MR imaging appearances of cardiac tumors, particularly of primary malignancies, differences in characteristic locations and features should allow confident differentiation between benign and malignant tumors. Indicators of malignancy at MR imaging are invasive behavior, involvement of the right side of the heart or the pericardium, tissue inhomogeneity, diameter greater than 5 cm, and enhancement after administration of gadolinium contrast material (as a result of higher tissue vascularity). Concomitant pericardial or pleural effusions are rare in benign processes but occur in about 50% of cases of malignant tumors. MR imaging offers improved resolution, a larger field of view, and superior soft-tissue contrast compared with those of echocardiography, suggesting that knowledge of the MR imaging features of cardiac neoplasms is important for accurate diagnosis and management.

© RSNA, 2005

References

  • 1 UrbaW, Longo D. Primary solid tumors of the heart. In: Kapoor A, ed. Cancer of the heart. New York, NY: Springer Verlag, 1986. Google Scholar
  • 2 SutschG, Jenni R, von Segesser L, Schneider J. Heart tumors: incidence, distribution, diagnosis—exemplified by 20,305 echocardiographies. Schweiz Med Wochenschr1991; 121: 621–629. MedlineGoogle Scholar
  • 3 FunariM, Fujita N, Peck WW, Higgins CB. Cardiac tumors: assessment with Gd-DTPA enhanced MR imaging. J Comput Assist Tomogr1991; 15: 953–958. Crossref, MedlineGoogle Scholar
  • 4 SemelkaRC, Shoenut JP, Wilson ME, Pellech AE, Patton JN. Cardiac masses: signal intensity features on spin-echo, gradient-echo, gadolinium-enhanced spin-echo, and TurboFLASH images. J Magn Reson Imaging1992; 2: 415–420. Crossref, MedlineGoogle Scholar
  • 5 SiripornpitakS, Higgins CB. MRI of primary and malignant cardiovascular tissue. J Comput Assist Tomogr1997; 21: 462–466. Crossref, MedlineGoogle Scholar
  • 6 MitchellDG, Burk DL Jr, Vinitski S, Rifkin MD. The biophysical basis of tissue contrast in extracranial MR imaging. AJR Am J Roentgenol1987; 149: 831–837. Crossref, MedlineGoogle Scholar
  • 7 DavisCP, McKinnon GC, Debatin JF, et al. Normal heart: evaluation with echo-planar MR imaging. Radiology1994; 191: 691–696. LinkGoogle Scholar
  • 8 StehlingMK, Holzknecht NG, Laub G, Bohm D, von Smekal A, Reiser M. Single-shot T1- and T2-weighted magnetic resonance imaging of the heart with black blood: preliminary experience. MAGMA1996; 4: 231–240. Crossref, MedlineGoogle Scholar
  • 9 SimonettiOP, Finn JP, White RD, Laub G, Henry DA. Black blood T2-weighted inversion recovery MR imaging of the heart. Radiology1996; 199: 49–57. LinkGoogle Scholar
  • 10 HoffmannU, Globits S, Schima W, et al. Usefulness of magnetic resonance imaging of cardiac and paracardiac masses. Am J Cardiol2003; 92: 890–895. Crossref, MedlineGoogle Scholar
  • 11 KimRJ, Wu E, Rafael A, et al. The use of contrast enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med2000; 343: 1445–1453. Crossref, MedlineGoogle Scholar
  • 12 Al-SaadiN, Nagel E, Gross M, et al. Non invasive detection of myocardial ischaemia from perfusion reserve based on cardiovascular magnetic resonance. Circulation2000; 101: 1379–1383. Crossref, MedlineGoogle Scholar
  • 13 PleinS, Ridgway JP, Jones TR, Bloomer TN, Sivananthan UM. Coronary artery disease: assessment with a comprehensive MR imaging protocol—initial results. Radiology2002; 225: 300–307. LinkGoogle Scholar
  • 14 ThieleH, Nagel E, Paetsch I, et al. Functional cardiac MR imaging with steady-state free precession (SSFP) significantly improves endocardial border delineation without contrast agents. J Magn Reson Imaging2001; 14: 362–367. Crossref, MedlineGoogle Scholar
  • 15 PleinS, Bloomer TN, Ridgway JP, Jones TR, Bainbridge GJ, Sivananthan UM. Steady-state free precession magnetic resonance imaging of the heart: comparison with segmented k-space gradient-echo imaging. J Magn Reson Imaging2001; 14: 230–236. Crossref, MedlineGoogle Scholar
  • 16 BurkeA, Virmani R. Tumors of the heart and great vessels. In: Atlas of tumor pathology. Washington, DC: Armed Forces Institute of Pathology, 1996; 1–98. Google Scholar
  • 17 CarneyJA. The Carney complex. Dermatol Clin1995; 13: 19–26. Crossref, MedlineGoogle Scholar
  • 18 CarneyJA, Gordon H, Carpenter PC, Shenoy BV, Go VL. The complex of myxomas, spotty pigmentation, and endocrine overactivity. Medicine (Baltimore)1985; 64: 270–283. Crossref, MedlineGoogle Scholar
  • 19 CarneyJA. The complex of myxomas, spotty pigmentation, and endocrine overactivity [editorial]. Arch Intern Med1987; 147: 418–419. Crossref, MedlineGoogle Scholar
  • 20 CaseyM, Mah C, Merliss AD, et al. Identification of a novel genetic locus for familial cardiac myxomas and Carney complex. Circulation1998; 98: 2560–2566. Crossref, MedlineGoogle Scholar
  • 21 MarkelML, Waller BF, Armstrong WF. Cardiac myxoma: a review. Medicine (Baltimore)1987; 66: 114–125. Crossref, MedlineGoogle Scholar
  • 22 GrebencML, Rosado-de-Christenson ML, Green CE, Burke A, Galvin JR. Cardiac myxoma: imaging features in 83 patients. RadioGraphics2002; 22: 673–689. LinkGoogle Scholar
  • 23 TazelaarHD, Locke TJ, McGregor CG. Pathology of excised primary cardiac tumors. Mayo Clin Proc1992; 67: 957–965. Crossref, MedlineGoogle Scholar
  • 24 EckhardtBP, Domamann-Scherer CC, Stuckmann G, Zollikofer CL, Wentz KU. Giant cardiac myxoma with malignant transformed structures. Eur Radiol2003; 13: 2099–2102. Crossref, MedlineGoogle Scholar
  • 25 TodoT, Usui M, Nagashima K. Cerebral metastasis of malignant cardiac myxoma. Surg Neurol1992; 37: 374–379. Crossref, MedlineGoogle Scholar
  • 26 RubinJI, Gomori JM, Grossman RI, Gefter WB, Kressel HY. High field MR imaging of extra-cranial hematomas. AJR Am J Roentgenol1987; 148: 813–817. Crossref, MedlineGoogle Scholar
  • 27 De RoosA, Weijers E, van Duinen S, van der Wall EE. Calcified right atrial myxoma demonstrated by magnetic resonance imaging. Chest1989; 95: 478–479. Crossref, MedlineGoogle Scholar
  • 28 MasuiT, Takahashi M, Miura K, Naito M, Tawarahara K. Cardiac myxoma: identification of intratumoral hemorrhage and calcification on MR images. AJR Am J Roentgenol1995; 164: 850–852. Crossref, MedlineGoogle Scholar
  • 29 MatsuokaH, Hamada M, Honda T, et al. Morphologic and histologic characterization of cardiac myxomas by magnetic resonance imaging. Angiology1996; 47: 693–698. Crossref, MedlineGoogle Scholar
  • 30 AraozPA, Mulvagh SL, Tazelaar HD, Julsrud PR, Breen JF. CT and MR imaging of benign primary cardiac neoplasms with echocardiographic correlation. RadioGraphics2000; 20: 1303–1319. LinkGoogle Scholar
  • 31 GomesAS, Lois JF, Child JS, Brown K, Batra P. Cardiac tumors and thrombus: evaluation with MR imaging. AJR Am J Roentgenol1987; 149: 895–899. Crossref, MedlineGoogle Scholar
  • 32 Lang-LazdunskiL, Oroudji M, Pansard Y, Vissuzaine C, Hvass U. Successful resection of giant intrapericardial lipoma. Ann Thorac Surg1994; 58: 238–240. Crossref, MedlineGoogle Scholar
  • 33 PuvaneswaryM, Edwards JR, Bastian BC, Khatri SK. Pericardial lipoma: ultrasound, computed tomography and magnetic resonance imaging findings. Australas Radiol2000; 44: 321–324. Crossref, MedlineGoogle Scholar
  • 34 MattaR, Neelakandhan KS, Sandhyamani S. Right atrial lipoma: case report. J Cardiovasc Surg (Torino)1996; 37: 165–168. MedlineGoogle Scholar
  • 35 HananouchiGI, Goff WB 2nd. Cardiac lipoma: six-year follow-up with MRI characteristics, and a review of the literature. Magn Reson Imaging1990; 8: 825–828. Crossref, MedlineGoogle Scholar
  • 36 HeyerCM, Kagel T, Lemburg SP, Bauer TT, Nicolas V. Lipomatous hypertrophy of the inter-atrial septum: a prospective study of incidence, imaging findings, and clinical symptoms. Chest2003; 124: 2068–2073. Crossref, MedlineGoogle Scholar
  • 37 EdwardsFH, Hale D, Cohen A, Thompson L, Pezella AT, Virmani R. Primary cardiac valve tumors. Ann Thorac Surg1991; 52: 1127–1131. Crossref, MedlineGoogle Scholar
  • 38 GrindaJM, Couteil JP, Chauvaud S, et al. Cardiac valve papillary fibroelastoma: surgical excision for revealed or potential embolization. J Thorac Cardiovasc Surg1999; 117: 106–110. Crossref, MedlineGoogle Scholar
  • 39 SunJP, Asher CR, Yang XS, et al. Clinical and echocardiographic characteristics of papillary fibroelastomas. Circulation2001; 103: 2687–2693. Crossref, MedlineGoogle Scholar
  • 40 WinterspergerBJ, Becker CR, Gulbins H, et al. Tumors of the cardiac valves: imaging findings in magnetic resonance imaging, electron beam computed tomography and echocardiography. Eur Radiol2000; 10: 443–449. Crossref, MedlineGoogle Scholar
  • 41 ShiraishiJ, Masashi T, Yamada T, et al. Papillary fibroelastoma of the aortic valve: evaluation with transoesophageal echocardiography and magnetic resonance imaging. Jpn Heart J2003; 44: 799–803. Crossref, MedlineGoogle Scholar
  • 42 KlarichKW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward JB. Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation. J Am Coll Cardiol1997; 30: 784–790. Crossref, MedlineGoogle Scholar
  • 43 BurkeAP, Rosado-de-Christenson M, Templeton PA, Virmani R. Cardiac fibroma: clinicopathologic correlates and surgical treatment. J Thorac Cardiovasc Surg1994; 108: 862–870. Crossref, MedlineGoogle Scholar
  • 44 BrownJJ, Barakos JA, Higgins CB. Magnetic resonance imaging of cardiac and paracardiac masses. J Thorac Imaging1989; 4: 58–59. Google Scholar
  • 45 BrechtelK, Reddy GP, Higgins CB. Cardiac fibroma in an infant: magnetic resonance imaging characteristics. J Cardiovasc Magn Reson1999; 1: 159–161. Crossref, MedlineGoogle Scholar
  • 46 KiaffasMG, Powell AJ, Geva T. Magnetic resonance imaging evaluation of cardiac tumor characteristics in infants and children. Am J Cardiol2002; 89: 1229–1233. Crossref, MedlineGoogle Scholar
  • 47 BrizardC, Latremouille C, Jebara VA, et al. Cardiac hemangiomas. Ann Thorac Surg1993; 56: 390–394. Crossref, MedlineGoogle Scholar
  • 48 BrodwaterB, Erasmus J, McAdams HP, Dodd L. Pericardial hemangioma. J Comput Assist Tomogr1996; 20: 954–956. Crossref, MedlineGoogle Scholar
  • 49 OshimaH, Hara M, Kono T, Shibamoto Y, Mishima A, Akita S. Cardiac hemangioma of the left atrial appendage: CT and MR findings. J Thorac Imaging2003; 18: 204–206. Crossref, MedlineGoogle Scholar
  • 50 LoLJ, Nucho RC, Allen JW, Rohde RL, Lau FY. Left atrial cardiac hemangioma associated with shortness of breath and palpitations. Ann Thorac Surg2002; 73: 979–981. Crossref, MedlineGoogle Scholar
  • 51 BerkenblitR, Spindola-Franco H, Frater RW, Fish BB, Glickstein JS. MRI in the evaluation and management of a newborn infant with cardiac rhabdomyoma. Ann Thorac Surg1997; 63: 1475–1477. Crossref, MedlineGoogle Scholar
  • 52 HoffmannU, Globits S, Frank H. Cardiac and paracardiac masses: current opinion on diagnostic evaluation by magnetic resonance imaging. Eur Heart J1998; 19: 553–563. Crossref, MedlineGoogle Scholar
  • 53 JaniganDT, Husain A, Robinson NA. Cardiac angiosarcomas: a review and a case report. Cancer1986; 57: 852–859. Crossref, MedlineGoogle Scholar
  • 54 KaminagaT, Takeshita T, Kimura I. Role of magnetic resonance imaging for evaluation of tumors in the cardiac region. Eur Radiol2003; 13(suppl 4): L1–L10. Crossref, MedlineGoogle Scholar
  • 55 BestAK, Dobson RL, Ahmad AR. Cardiac angiosarcoma. RadioGraphics2003; 23(spec no): S141–S145. LinkGoogle Scholar
  • 56 BrunaJ, Lockwood M. Primary heart angiosarcoma detected by computed tomography and magnetic resonance imaging. Eur Radiol1998; 8: 66–68. Crossref, MedlineGoogle Scholar
  • 57 YahataS, Endo T, Honma H, et al. Sunray appearance on enhanced magnetic resonance image of cardiac angiosarcoma with pericardial obliteration. Am Heart J1994; 127: 468–471. Crossref, MedlineGoogle Scholar
  • 58 DonsbeckAV, Ranchere D, Coindre JM, Le Gall F, Cordier JF, Loire R. Primary cardiac sarcomas: an immunohistochemical and grading study with long term follow up of 24 cases. Histopathology1999; 34: 295–304. Crossref, MedlineGoogle Scholar
  • 59 ItohK, Matsumara T, Egawa Y. Primary mitral valve sarcoma in infancy. Pediatr Cardiol1998; 19: 174–177. Crossref, MedlineGoogle Scholar
  • 60 AraozPA, Eklund HE, Welch TJ, et al. CT and MRI of primary cardiac malignancies. RadioGraphics1999; 19: 1421–1434. LinkGoogle Scholar
  • 61 VillacampaVM, Villarreal M, Ros LH, Alvarez R, Cozar M, Fuertes MI. Cardiac rhabdomyosarcoma: diagnosis by MR imaging. Eur Radiol1999; 9: 634–637. Crossref, MedlineGoogle Scholar
  • 62 SchvartzmanPR, White R. Imaging of cardiac and paracardiac masses. J Thorac Imaging2000; 15: 265–273. Crossref, MedlineGoogle Scholar
  • 63 YamagishiM, Yamada N, Kuribayashi S. Images in cardiology: magnetic resonance imaging of cardiac osteosarcoma. Heart2001; 85: 311. Crossref, MedlineGoogle Scholar
  • 64 LuritoKJ, Martin T, Cordes T. Right atrial cardiac osteosarcoma. Pediatr Cardiol2002; 23: 462–465. Crossref, MedlineGoogle Scholar
  • 65 DurandE, Vanel D, Mousseaux E, Meingan P, Fornes P, Bittoun J. A recurrent left atrium leiomyosarcoma. Eur Radiol1998; 8: 97–99. Crossref, MedlineGoogle Scholar
  • 66 LoFL, Chou YH, Tiu CM, et al. Primary cardiac leiomyosarcoma: imaging with 2D echocardiography, electron beam CT and 1.5 Tesla MR. Eur J Radiol1998; 27: 72–76. Crossref, MedlineGoogle Scholar
  • 67 ClarkeNR, Mohiaddin RH, Westaby S, Banning AP. Multifocal cardiac leiomyosarcoma: diagnosis and surveillance by transoesophageal echocardiography and contrast enhanced cardiovascular magnetic resonance. Postgrad Med J2002; 78: 492–493. Crossref, MedlineGoogle Scholar
  • 68 CeresoliGL, Ferreri AJ, Bucci E, Ripa C, Ponzoni M, Villa E. Primary cardiac lymphoma in immunocompetent patients. Cancer1997; 80: 1497–1506. Crossref, MedlineGoogle Scholar
  • 69 RyuSJ, Choi BW, Choe KO. CT and MR findings of primary cardiac lymphoma: report upon 2 cases and review. Yonsei Med J2001; 42: 451–456. Crossref, MedlineGoogle Scholar
  • 70 DorsayTA, Ho VB, Rovira MJ, Armstrong MA, Brissette MD. Primary cardiac lymphoma: CT and MR findings. J Comput Assist Tomogr1993; 17: 978–981. Crossref, MedlineGoogle Scholar
  • 71 TadaH, Asazuma K, Ohya E, et al. Primary cardiac B cell lymphoma. Circulation1998; 97: 220–221. Crossref, MedlineGoogle Scholar
  • 72 TjeerdsmaG, Brouwer J, Van Veldhuisen DJ. Rapid progression of pericardial malignant mesothelioma. Heart1998; 79: 618. Crossref, MedlineGoogle Scholar
  • 73 OhnishiJ, Shiotani H, Ueno H, Fujita N, Matsunaga K. Primary pericardial mesothelioma demonstrated by magnetic resonance imaging. Jpn Circ J1996; 60: 898–900. Crossref, MedlineGoogle Scholar
  • 74 AbrahamKP, Reddy V, Gattuso P. Neoplasms metastatic to the heart: review of 3314 consecutive autopsies. Am J Cardiovasc Pathol1990; 3: 195–198. MedlineGoogle Scholar
  • 75 KlattEC, Heitz DR. Cardiac metastases. Cancer1990; 65: 1456–1459. Crossref, MedlineGoogle Scholar
  • 76 MacGeeW. Metastatic and invasive tumors involving the heart in a geriatric population: a necropsy study. Virchows Arch A Pathol Anat Histopathol1991; 419: 183–189. Crossref, MedlineGoogle Scholar
  • 77 MousseauxE, Meunier P, Azancott S, Dubayle P, Gaux JC. Cardiac metastatic melanoma investigated by magnetic resonance imaging. Magn Reson Imaging1998; 16: 91–95. Crossref, MedlineGoogle Scholar
  • 78 EnochsWS, Petherick P, Bogdanova A, Mohr U, Weissleder R. Paramagnetic scavenging by melanin: MR imaging. Radiology1997; 204: 417–423. LinkGoogle Scholar
  • 79 HancockEW. Neoplastic pericardial disease. Cardiol Clin1990; 8: 673–682. Crossref, MedlineGoogle Scholar
  • 80 PaydarfarD, Krieger D, Dib N, et al. In vivo magnetic resonance imaging and surgical histopathology of intracardiac masses: distinct features of subacute thrombi. Cardiology2001; 95: 40–47. Crossref, MedlineGoogle Scholar
  • 81 WhiteCS. MR evaluation of the pericardium. Top Magn Reson Imaging1995; 7: 258–266. Crossref, MedlineGoogle Scholar
  • 82 MendelsonDS, Rose JS, Efremidis SC, Kirschner PA, Cohen BA. Bronchogenic cysts with high CT numbers. AJR Am J Roentgenol1983; 140: 463–465. Crossref, MedlineGoogle Scholar
  • 83 NakataH, Egashira K, Watanabe H, et al. MRI of bronchogenic cysts. J Comput Assist Tomogr1993; 17: 267–270. Crossref, MedlineGoogle Scholar
  • 84 LyonRD, McAdams HP. Mediastinal bronchogenic cyst: demonstration of a fluid-fluid level at MR imaging. Radiology1993; 186: 427–428. LinkGoogle Scholar

Article History

Published in print: Sept 2005