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      Diagnosis of pericardial cysts using diffusion weighted magnetic resonance imaging: A case series

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          Abstract

          Introduction

          Congenital pericardial cysts are benign lesions that arise from the pericardium during embryonic development. The diagnosis is based on typical imaging features, but atypical locations and signal magnetic resonance imaging sequences make it difficult to exclude other lesions. Diffusion-weighted magnetic resonance imaging is a novel method that can be used to differentiate tissues based on their restriction to proton diffusion. Its use in differentiating pericardial cysts from other pericardial lesions has not yet been described.

          Case presentation

          We present three cases (a 51-year-old Caucasian woman, a 66-year-old Caucasian woman and a 77-year-old Caucasian woman) with pericardial cysts evaluated with diffusion-weighted imaging using cardiac magnetic resonance imaging. Each lesion demonstrated a high apparent diffusion coefficient similar to that of free water.

          Conclusion

          This case series is the first attempt to investigate the utility of diffusion-weighted magnetic resonance imaging in the assessment of pericardial cysts. Diffusion-weighted imaging may be a useful noninvasive diagnostic tool for pericardial cysts when conventional imaging findings are inconclusive.

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          Imaging of cystic masses of the mediastinum.

          Jean-Louis Dietemann, Bernard Gasser, Dominique Charneau … (2002)
          Cystic masses of the mediastinum are well-marginated round lesions that contain fluid and are lined with epithelium. Major cystic masses include congenital benign cysts (ie, bronchogenic, esophageal duplication, neurenteric, pericardial, and thymic cysts), meningocele, mature cystic teratoma, and lymphangioma. Many tumors (eg, thymomas, Hodgkin disease, germ cell tumors, mediastinal carcinomas, metastases to lymph nodes, nerve root tumors) can undergo cystic degeneration-especially after radiation therapy or chemotherapy-and demonstrate mixed solid and cystic elements at computed tomography (CT) or magnetic resonance (MR) imaging. If degeneration is extensive, such tumors may be virtually indistinguishable from congenital cysts. A mediastinal abscess or pancreatic pseudocyst also appears as a fluid-containing mediastinal cystic mass. However, clinical history and manifestations, anatomic position, and certain details seen at CT or MR imaging allow correct diagnosis in many cases. Familiarity with the radiologic features of mediastinal cystic masses facilitates accurate diagnosis, differentiation from other cystlike lesions, and, thus, optimal patient treatment. Copyright RSNA, 2002
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            Pericardial cyst: case reports and a literature review.

            Smadar Kort, Chong Yon Park, Lee S. Rosen … (2004)
            Pericardial cysts are rare mediastinal abnormalities, which are usually congenital but may also be acquired after cardiothoracic surgery. Cysts frequently occur in the right cardiophrenic angle and their diagnosis is usually suspected after an abnormal chest X ray is obtained. The presence of a pericardial cyst in this typical location or, less frequently, in an unusual location, poses a diagnostic challenge in distinguishing it from other intracardiac or mediastinal abnormalities. Two-dimensional echocardiography and transesophageal echocardiography are extremely valuable in diagnosing the presence of a pericardial cyst. Although most pericardial cysts are asymptomatic, patients may present with chest pain and dyspnea. In addition, life-threatening complications such as pericardial tamponade have been reported in association with pericardial cysts. The following cases illustrate the usefulness of two-dimensional echocardiography in making an accurate diagnosis of a pericardial cyst, as well as in follow-up of these patients for the development of possible complications.
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              Diffusion-weighted magnetic resonance imaging in focal breast lesions: analysis of 78 cases with pathological correlation.

              L Pinali, F Fornasa, S Montemezzi … (2011)
              This study assessed the usefulness of magnetic resonance diffusion-weighted imaging (DWI) in distinguishing between benign and malignant breast lesions. Gadolinium-enhanced magnetic resonance imaging (MRI) and DWI with determination of the apparent diffusion coefficient (ADC) were performed on 78 women, each with a focal breast lesion at least 7 mm in diameter, which was studied by cytology or histology. Final diagnoses were obtained by cytology in 29 cases and histology in 49 (11 percutaneous biopsies and 38 surgical specimens). There were 43 benign lesions (13 fibrocystic disease, eight fibroadenoma, seven adenosis, five normal breast tissue, four inflammatory lesions, three intramammary lymph nodes, two scleroelastosis and one fat necrosis) and 35 malignant lesions (30 invasive ductal carcinoma, two invasive lobular carcinoma, one ductal carcinoma in situ, one carcinomatous mastitis and one metastasis from neuroendocrine carcinoma). The mean ADC values were 1.677±0.151 for benign lesions and 1.298±0.129 for malignant lesions (p<0.001). With an ADC cutoff value of 1.48, DWI had 88.6% sensitivity [confidence interval (CI) 78.1%-99.1%] and 95.3% specificity (CI 88.9%-100%), with 31 true positives, four false negatives (three invasive ductal carcinoma and one carcinomatous mastitis), 41 true negatives and two false positives (one fat necrosis and one fibroadenoma). With the cutoff value set at 1.52, DWI sensitivity (35 true positive, no false negative) was 100% and specificity was 86% (CI 75.7%-96.3%) due to 37 true negatives and six false positives (an additional two fibroadenoma and two fibrocystic disease compared with those recorded with the cutoff set at 1.48). The overall accuracy of DWI considering both cutoff values (72 correct evaluations out of 78 cases) was 92.3% (CI 86.4%-98.2%). DWI is a reliable tool for characterising focal breast lesions.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Med Case Reports
                Title: Journal of Medical Case Reports
                Publisher: BioMed Central
                ISSN (Electronic): 1752-1947
                Publication date Collection: 2011
                Publication date (Electronic): 24 September 2011
                Volume: 5
                Page: 479
                Affiliations
                [1 ]Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
                [2 ]Institute of Cardiovascular Sciences, St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
                [3 ]Section of Internal Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
                [4 ]Section of Cardiology, Department of Internal Medicine, Bergen Cardiac Care Centre, St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
                Article
                Publisher ID: 1752-1947-5-479
                DOI: 10.1186/1752-1947-5-479
                PMC ID: 3189152
                PubMed ID: 21943086
                SO-VID: 58d9122a-6fef-4175-baaf-d498c1a75647
                Copyright © Copyright ©2011 Raja et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 8 March 2011
                Date accepted : 24 September 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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