Myxoma MRI: Difference between revisions

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__NOTOC__
__NOTOC__
{{Myxoma}}
{{Myxoma}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} {{AE}} {{AAM}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{MV}} {{CZ}} {{AAM}}
==Overview==
==Overview==
Cardiac Magnetic resonance Imaging can help non-invasively in diagnosing Myxoma.
==MRI==
<div align="left">
<gallery heights="225" widths="225">
Image:Left atrial myxoma MRI 1.jpg|Axial T1-weighted MRI shows a soft tissue mass within the left atrium isointense to skeletal muscle (arrowheads). A friable myxoma was removed from the left atrium of a 53-year-old man with cerebrovascular accidents.


</gallery>
Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3]
</div>
 
===Cardiac MRI in myxoma===
On Magnetic Resonance Imaging (MRI) or ''Cardiac Magenetic Resonance (CMR)'' , cardiac myxoma is characterized by a [[soft tissue]] mass within the [[cardiac chambers]] that is isointense to [[skeletal muscle]]. This imaging modality, plays an important role in the evaluation of cardiac masses and is of great value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.<ref name="pmid">{{cite journal |vauthors=Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR |title=Cardiac myxoma: imaging features in 83 patients |journal=Radiographics |volume=22 |issue=3 |pages=673–89 |year=2002 |pmid= |doi=10.1148/radiographics.22.3.g02ma02673 |url=}}</ref>
 
==Key MRI Findings in Cardiac Myxoma==
 
MRI appearances are heterogeneous, reflecting the non-uniformity of these masses. They are typically spherical or ovoid masses which may be sessile or pedunculated.<ref>Cardiac Myxomas. Radiopedia.http://radiopaedia.org/articles/cardiac-myxoma Accessed November 25, 2015</ref>
 
*'''T1''': tend to be low to intermediate signal, but areas of haemorrhage may be high.
*'''T2''': can be variable due to heterogeneity in tumor componants; e.g calcific components > low signal; myxomatous components  > high signal.
*'''GE (gradient echo)''': may show blooming of calcific components.
*'''T1 C+ (Gd)''': shows enhancement (important discriminator from a thrombus).
 
==MRI Examples of Cardiac Myxoma==
===Cardiac MRI in Myxoma===
====ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance<ref name="pmid20479157">{{cite journal| author=American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA et al.| title=ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. | journal=Circulation | year= 2010 | volume= 121 | issue= 22 | pages= 2462-508 | pmid=20479157 | doi=10.1161/CIR.0b013e3181d44a8f | pmc=PMC3034132 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20479157  }} </ref> (DO NOT EDIT)====
====ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance<ref name="pmid20479157">{{cite journal| author=American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA et al.| title=ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. | journal=Circulation | year= 2010 | volume= 121 | issue= 22 | pages= 2462-508 | pmid=20479157 | doi=10.1161/CIR.0b013e3181d44a8f | pmc=PMC3034132 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20479157  }} </ref> (DO NOT EDIT)====
{{cquote|
{{cquote|
CMR may be used for clinical evaluation of cardiac masses, extracardiac structures, and involvement and characterization of masses in the differentiation of tumors from thrombi.
CMR may be used for clinical evaluation of cardiac masses, extracardiac structures, and involvement and characterization of masses in the differentiation of tumors from thrombi.
}}
}}
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Imaging Technique}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Features}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Advantages}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Limitations}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|'''Two- or three-dimensional echocardiography'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Echocardiography is usually the initial modality used for identification and evaluation of cardiac myxomas.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Hyperechogenic lesions with a well-defined stalk.
*Protrusion into the ventricles is a common finding.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Real-time imaging
*Tumor mobility and distensibility.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Limited views of the mediastinum and cannot be used to evaluate extracardiac manifestations of disease.<ref name="pmid1943240">{{cite journal |vauthors=Reeder GS, Khandheria BK, Seward JB, Tajik AJ |title=Transesophageal echocardiography and cardiac masses |journal=Mayo Clin. Proc. |volume=66 |issue=11 |pages=1101–9 |year=1991 |pmid=1943240 |doi= |url=}}</ref>
*TEE is an invasive imaging technique.
*TT is limited by the imaging window, which can vary with the patient and operator experience.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|'''MRI'''
| style="padding: 5px 5px; background: #DCDCDC;" align=center|
*Evaluation of cardiac masses and is of greatest value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.
| style="padding: 5px 5px; background: #DCDCDC;" align=center|
*Cardiac myxomas appear spherical or ovoid with lobular contours, irregular in shape.
*'''T1''' : Low to intermediate signal, but areas of hemorrhage may be high.
*'''T1 C+ (Gd)''': shows enhancement (important discriminator from a thrombus) demonstrates uniform heterogeneous enhancement.
| style="padding: 5px 5px; background: #DCDCDC;" align=center|
* MRI allows imaging in multiple planes.
* Provides some functional information such as, flow direction and flow velocity in large vessels.
| style="padding: 5px 5px; background: #DCDCDC;" align=center|
*Cannot show calcification.
*High susceptibility to motion artifact.
*Dependent on regular electrocardiographic rhythms and cardiac gating.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|'''CT'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*CT can be used to accurately image the heart and surrounding mediastinum.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Intracardiac heterogeneously low attenuating mass.
*The attenuation is usually lower than that of myocardium.
*Calcification is common
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*CT provides better soft-tissue contrast.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*There is no real-time true imaging with CT and imaging planes are limited to those allowed by angulation of the gantry.
*There is no evaluation of small moving structures, such as the cardiac valves.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|'''Angiography'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Coronary angiography may be helpful to detect vascular supply of the tumor by the coronary arteries.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of tortuous vessels that correspond to tumor vasculature
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma.
*Helpful for surgical evaluation.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Invasive imaging technique
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|'''Chest x-ray'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Chest x-ray has no particular findings associated with cardiac myxoma.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Results can be normal.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Low cost
*May be helpful, if calcifications present.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Does not provide a diagnosis.
|-
|}


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Cardiology]]
[[Category:Surgery]]

Latest revision as of 19:14, 28 April 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Maria Fernanda Villarreal, M.D. [2] Cafer Zorkun, M.D., Ph.D. [3] Ahmad Al Maradni, M.D. [4]

Overview

Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3]

On Magnetic Resonance Imaging (MRI) or Cardiac Magenetic Resonance (CMR) , cardiac myxoma is characterized by a soft tissue mass within the cardiac chambers that is isointense to skeletal muscle. This imaging modality, plays an important role in the evaluation of cardiac masses and is of great value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.[1]

Key MRI Findings in Cardiac Myxoma

MRI appearances are heterogeneous, reflecting the non-uniformity of these masses. They are typically spherical or ovoid masses which may be sessile or pedunculated.[2]

  • T1: tend to be low to intermediate signal, but areas of haemorrhage may be high.
  • T2: can be variable due to heterogeneity in tumor componants; e.g calcific components > low signal; myxomatous components > high signal.
  • GE (gradient echo): may show blooming of calcific components.
  • T1 C+ (Gd): shows enhancement (important discriminator from a thrombus).

MRI Examples of Cardiac Myxoma

Cardiac MRI in Myxoma

ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance[3] (DO NOT EDIT)

CMR may be used for clinical evaluation of cardiac masses, extracardiac structures, and involvement and characterization of masses in the differentiation of tumors from thrombi.


Imaging Technique Features Description Advantages Limitations
Two- or three-dimensional echocardiography
  • Echocardiography is usually the initial modality used for identification and evaluation of cardiac myxomas.
  • Hyperechogenic lesions with a well-defined stalk.
  • Protrusion into the ventricles is a common finding.
  • Real-time imaging
  • Tumor mobility and distensibility.
  • Limited views of the mediastinum and cannot be used to evaluate extracardiac manifestations of disease.[4]
  • TEE is an invasive imaging technique.
  • TT is limited by the imaging window, which can vary with the patient and operator experience.
MRI
  • Evaluation of cardiac masses and is of greatest value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.
  • Cardiac myxomas appear spherical or ovoid with lobular contours, irregular in shape.
  • T1 : Low to intermediate signal, but areas of hemorrhage may be high.
  • T1 C+ (Gd): shows enhancement (important discriminator from a thrombus) demonstrates uniform heterogeneous enhancement.
  • MRI allows imaging in multiple planes.
  • Provides some functional information such as, flow direction and flow velocity in large vessels.
  • Cannot show calcification.
  • High susceptibility to motion artifact.
  • Dependent on regular electrocardiographic rhythms and cardiac gating.
CT
  • CT can be used to accurately image the heart and surrounding mediastinum.
  • Intracardiac heterogeneously low attenuating mass.
  • The attenuation is usually lower than that of myocardium.
  • Calcification is common
  • CT provides better soft-tissue contrast.
  • There is no real-time true imaging with CT and imaging planes are limited to those allowed by angulation of the gantry.
  • There is no evaluation of small moving structures, such as the cardiac valves.
Angiography
  • Coronary angiography may be helpful to detect vascular supply of the tumor by the coronary arteries.
  • The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of tortuous vessels that correspond to tumor vasculature
  • Angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma.
  • Helpful for surgical evaluation.
  • Invasive imaging technique
Chest x-ray
  • Chest x-ray has no particular findings associated with cardiac myxoma.
  • Results can be normal.
  • Low cost
  • May be helpful, if calcifications present.
  • Does not provide a diagnosis.

References

  1. Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR (2002). "Cardiac myxoma: imaging features in 83 patients". Radiographics. 22 (3): 673–89. doi:10.1148/radiographics.22.3.g02ma02673.
  2. Cardiac Myxomas. Radiopedia.http://radiopaedia.org/articles/cardiac-myxoma Accessed November 25, 2015
  3. American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA; et al. (2010). "ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents". Circulation. 121 (22): 2462–508. doi:10.1161/CIR.0b013e3181d44a8f. PMC 3034132. PMID 20479157.
  4. Reeder GS, Khandheria BK, Seward JB, Tajik AJ (1991). "Transesophageal echocardiography and cardiac masses". Mayo Clin. Proc. 66 (11): 1101–9. PMID 1943240.


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