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      Multidetector CT and MR Imaging of Cardiac Tumors

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          Abstract

          The purpose of this article is to provide a current review of the spectrum of multidetector CT (MDCT) and MRI findings for a variety of cardiac neoplasms. In the diagnosis of cardiac tumors, the use of MDCT and MRI can help differentiate benign from malignant masses. Especially, the use of MDCT is advantageous in providing anatomical information and MRI is useful for tissue characterization of cardiac masses. Knowledge of the characteristic MRI findings of benign cardiac tumors or thrombi can be helpful to avoid unnecessary surgical procedures. Presurgical assessment of malignant cardiac tumors with the use of MDCT and MRI may allow determination of the resectability of tumors and planning for the reconstruction of cardiac chambers.

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          Most cited references 25

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          Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies.

          Cardiac involvement by primary and secondary tumors is one of the least investigated subjects in oncology. Seven cases of primary and 154 cases of secondary cardiac tumors from autopsies performed over a 20-year period (1972 through 1991) at Queen Mary Hospital, Hong Kong, were reviewed. During this period, 12,485 autopsies were performed, and the autopsy incidence for primary and secondary heart tumors is thus 0.056% and 1.23%, respectively. Only seven primary cardiac tumors were found, including two myxomas, two rhabdomyomas, two hemangiomas, and one lipoma. For secondary tumors involving the heart (including both metastasis and local extension), important primary tumors in male subjects were carcinoma of the lung (31.7%), esophageal carcinoma (28.7%), lymphoma (11.9%), carcinoma of the liver (6.9%), leukemia (4.0%), and gastric carcinoma (4.0%), while in female subjects, carcinoma of the lung (35.9%), lymphoma (17.0%), carcinoma of the breast (7.5%), and pancreatic carcinoma (7.5%) predominated. Overall, the three most common malignant neoplasms encountered were carcinoma of the lung, esophageal carcinoma, and lymphoma. Pericardium, including epicardium, was the most common location of cardiac involvement by secondary tumors, followed by myocardium and endocardium. The present study showed a higher percentage of esophageal carcinoma and carcinoma of the liver (reflecting the higher incidence of these tumors in Hong Kong Chinese), but a lower incidence of carcinoma of the breast when compared with other series. The metastatic lung tumors showed an unusual predominance of adenocarcinoma.
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            Cardiac metastases.

            The authors found metastases to the heart in 10.7% of 1029 autopsy cases in which a malignant neoplasm was diagnosed. The lung was the commonest primary site (36.4%) and adenocarcinoma was the most frequent cell type (36.4%) of neoplasms metastatic to heart. Nonepithelial tumors accounted for 22.7% of cardiac metastases. Epicardium was involved in 75.5% of metastatic lesions and a pericardial effusion was present with 33.7% of epicardial metastases. Although hemorrhagic effusions occurred in only 12 cases with metastases to heart, these represented 76.4% of all such effusions. Lymphomas associated with the acquired immune deficiency syndrome showed the most extensive cardiac involvement. Primary sites and cell types of cardiac metastases have evolved over time and have been modified by chemotherapy, increased survival of cancer patients, increasing incidence of lung carcinoma, and recently by the acquired immune deficiency syndrome epidemic.
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              Primary cardiac valve tumors.

              To investigate the characteristics of primary cardiac valve tumors, we retrospectively analyzed our multiinstitutional experience from 1932 through 1990. We encountered 56 valvular tumors in 53 patients. The average age of these patients was 52 years (range, 2 to 88 years) and 79% (42/53) were male. Symptoms were present in 38% (20/53) and were neurological in 15% (8/53). Four patients experienced sudden death. Each of the four valves was affected with approximately equal frequency: 16 aortic, 15 mitral, 13 pulmonary, and 12 tricuspid. All but four tumors were benign. The most common histological type was papillary fibroelastoma (41), followed by myxomas (5), fibromas (4), sarcomas (2), hamartoma (1), hemangioma (1), histiocytoma (1), and undifferentiated (1). Average tumor size was 1.15 cm (range, 3 mm to 7 cm), and the average size of fibroelastomas was 8 mm (range, 3 to 15 mm). Mitral valve tumors were more likely than aortic valve tumors to produce serious neurological symptoms or sudden death (8/15 versus 3/16; p less than 0.05). Six patients underwent echocardiography, and results were positive in each. All 6 underwent uncomplicated valve repair or replacement. Compared with a series of 407 nonvalvular tumors, cardiac valve tumors are more likely to occur in male patients (p less than 0.001) and adults (p less than 0.001). Valve tumors are also more commonly benign (p less than 0.001) and asymptomatic (p less than 0.001). These tumors demonstrate somewhat less aggressive behavior compared with non-valvular tumors, but their distinct propensity to produce serious clinical sequelae argues in favor of surgical resection for all cardiac valve tumors.
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                Author and article information

                Journal
                Korean J Radiol
                KJR
                Korean Journal of Radiology
                The Korean Society of Radiology
                1229-6929
                2005-8330
                Mar-Apr 2009
                03 March 2009
                : 10
                : 2
                : 164-175
                Affiliations
                [1 ]Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
                [2 ]Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
                [3 ]Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
                [4 ]Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
                Author notes
                Address reprint requests to: Yeon Hyeon Choe, MD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel. (822) 3410-2509, Fax. (822) 3410-2559, yhchoe@ 123456skku.edu
                Article
                10.3348/kjr.2009.10.2.164
                2651440
                19270863
                Copyright © 2009 The Korean Society of Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Pictorial Essay

                Radiology & Imaging

                magnetic resonance (mr), multidetector ct, cardiac tumor

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