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      Evaluation of a cardiac sarcoma with CT multislice contrast-enhanced and 18FDG-PET/TC

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          Abstract

          We present the case of an adult male who arrived to our emergency room with progressive dyspnea that had been ongoing for 2 months. During the radiological investigation, we found a large intracardiac mass, which invaded the pericardium, pulmonary trunk, pulmonary arteries, and left ventricle. Studies done with the 18FDG-PET/CT scan helped us to determine the malignant nature of the mass and to suspect the diagnosis of rhabdomyosarcoma.

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          Most cited references 11

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          Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT.

          In the diagnostic algorithm of cardiac tumors, the noninvasive determination of malignancy and metastatic spread is of major interest to stratify patients and to select and monitor therapies. In the diagnostic work-up, morphologic imaging modalities such as echocardiography or magnetic resonance tomography offer information on, for example, size, invasiveness, and vascularization. However, preoperative assessment of malignancy may be unsatisfactory. The aim of this study was to evaluate the diagnostic value of (18)F-FDG PET and the incremental diagnostic value of an optimized CT score in this clinical scenario. (18)F-FDG PET/CT scans (whole-body imaging with low-dose CT) of 24 consecutive patients with newly diagnosed cardiac tumors were analyzed (11 men, 13 women; mean age ± SD, 59 ± 13 y). The maximum standardized uptake values (SUV(max)) of the tumors were measured. Patients were divided into 2 groups: benign cardiac tumors (n = 7) and malignant cardiac tumors (n = 17) (cardiac primaries [n = 8] and metastases [n = 9]). SUV(max) was compared between the 2 groups. Results were compared with contrast-enhanced CT, using standardized criteria of malignancy. Histology served as ground truth. Mean SUV(max) was 2.8 ± 0.6 in benign cardiac tumors and significantly higher both in malignant primary and in secondary cardiac tumors (8.0 ± 2.1 and 10.8 ± 4.9, P < 0.01). Malignancy was determined with a sensitivity of 100% and specificity of 86% (accuracy, 96%), after a cutoff with high sensitivity (SUV(max) of 3.5) was chosen to avoid false-negatives. Morphologic imaging reached a sensitivity of 82% and a specificity of 86% (accuracy, 83%). Both false-positive and false-negative decisions in morphology could be corrected in all but 1 case using a metabolic threshold with an SUV(max) of 3.5. In addition, extracardiac tumor manifestations were detected in 4 patients by whole-body (18)F-FDG PET/CT. (18)F-FDG PET/CT can aid the noninvasive preoperative determination of malignancy and may be helpful in detecting metastases of malignant cardiac tumors.
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            Malignant tumours of the heart: a review of tumour type, diagnosis and therapy.

            Primary cardiac neoplasms are rare and occur less commonly than metastatic disease of the heart. In this overview, current published studies concerning malignant neoplasms of the heart are reviewed, together with some insights into their aetiology, diagnosis and management. We searched medline using the subject 'cardiac neoplasms'. We selected about 110 articles from between 1973 and 2006, of which 76 sources were used to complete the review. Sarcomas are the most common cardiac tumours and include myxosarcoma, liposarcoma, angiosarcoma, fibrosarcoma, leiomyosarcoma, osteosarcoma, synovial sarcoma, rhabdomyosarcoma, neurofibrosarcoma, malignant fibrous histiocytoma and undifferentiated sarcoma. The classic symptoms of cardiac tumours are intracardiac obstruction, signs of systemic embolisation, and systemic or constitutional symptoms. However, serious complications including stroke, myocardial infarction and even sudden death from arrhythmia may be the first signs of a tumour. Echocardiography and angiography are essential diagnostic tools for evaluating cardiac neoplasms. Computed tomography and magnetic resonance imaging studies have improved the diagnostic approach in recent decades. Successful treatment for benign cardiac tumours is usually achieved by surgical resection. Unfortunately, resection of the tumour is not always feasible. The prognosis after surgery is usually excellent in the case of benign tumours, but the prognosis of malignant tumours remains dismal. In conclusion, there are limited published data concerning cardiac neoplasms. Therefore, a high level of suspicion is required for early diagnosis. Surgery is the cornerstone of therapy. However, a multi-treatment approach, including chemotherapy, radiation as well as evolving approaches such as gene therapy, might provide a better palliative and curative result.
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              Neoplasms metastatic to the heart: review of 3314 consecutive autopsies.

              Cardiac involvement by metastatic neoplasms is relatively uncommon and usually occurs with widely disseminated disease. Ninety-five cases with cardiac metastases from autopsies performed over a 14-year period (1974-1987) at Loyola University Medical Center are reviewed. During this period, 3314 autopsies were performed with an average annual autopsy rate of 35%. In 806 (24.3%), a malignant disease was found, and in 95 (11.8%), there was cardiac involvement by tumor. The most common malignancies encountered in order of decreasing frequency were lung, lymphoma, breast, leukemia, stomach, melanoma, liver, and colon. Although the percentage of cardiac metastasis compares favorably with previous reports in the literature, an identical rate was present during both halves of the 14-year period studied. Improved diagnostic capabilities and treatment protocols in recent years have apparently not significantly affected the incidence, distribution, or patterns of metastatic spread to the heart.
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                Author and article information

                Contributors
                Journal
                Radiol Case Rep
                Radiol Case Rep
                Radiology Case Reports
                Elsevier
                1930-0433
                17 December 2018
                March 2019
                17 December 2018
                : 14
                : 3
                : 368-371
                Affiliations
                Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, Rome 00133, Italy
                Author notes
                [* ]Corresponding author. adrianolacche@ 123456gmail.com
                Article
                S1930-0433(18)30513-2
                10.1016/j.radcr.2018.12.002
                6299141
                © 2018 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                Categories
                PET/CT

                cardiac sarcoma, computed tomography, pet/ct

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