Characterization of Cardiac Tumors in Children by Cardiovascular Magnetic Resonance Imaging: A Multicenter Experience

The aim of this study was to report the results of an international multicenter experience of cardiac magnetic resonance imaging (MRI) evaluation of cardiac tumors in children, each with histology correlation or a diagnosis of tuberous sclerosis, and to determine which characteristics are predictive...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2011-08, Vol.58 (10), p.1044-1054
Main Authors: BEROUKHIM, Rebecca S, PRAKASH, Ashwin, MISRA, Nilanjana, MONIOTTE, Stephane, JAMES PARKS, W, POWELL, Andrew J, SORIANO, Brian D, SRICHAI, Monvadi B, YOO, Shi-Joon, JING ZHOU, GEVA, Tal, VALSANGIACOMO BUECHEL, Emanuela R, CAVA, Joseph R, DORFMAN, Adam L, FESTA, Pierluigi, HLAVACEK, Anthony M, JOHNSON, Tiffanie R, KELLER, Marc S, KRISHNAMURTHY, Rajesh
Format: Article
Language:English
Subjects:
Adolescent
Anesthesia
Biological and medical sciences
Biopsy
Blood clots
Cardiology
Cardiology. Vascular system
Child
Child, Preschool
Children & youth
Cysts
Diagnostic Errors
Female
Fibroma - pathology
Heart
Heart attacks
Heart Neoplasms - pathology
Hemangioma - pathology
Humans
Infant
Magnetic Resonance Imaging
Male
Medical sciences
Myocardium - pathology
NMR
Nuclear magnetic resonance
Pathology
Retrospective Studies
Rhabdomyoma - pathology
Teratoma - pathology
Tumors
Tumors of the heart
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Summary:The aim of this study was to report the results of an international multicenter experience of cardiac magnetic resonance imaging (MRI) evaluation of cardiac tumors in children, each with histology correlation or a diagnosis of tuberous sclerosis, and to determine which characteristics are predictive of tumor type. Individual centers have relatively little experience with diagnostic imaging of cardiac tumors in children, because of their low prevalence. The accuracy of cardiac MRI diagnosis on the basis of a pre-defined set of criteria has not been tested. An international group of pediatric cardiac imaging centers was solicited for case contribution. Inclusion criteria comprised: 1) age at diagnosis ≤18 years; 2) cardiac MRI evaluation of cardiac tumor; and 3) histologic diagnosis or diagnosis of tuberous sclerosis. Data from the cardiac MRI images were analyzed for mass characteristics. On the basis of pre-defined cardiac MRI criteria derived from published data, 3 blinded investigators determined tumor type, and their consensus diagnoses were compared with histologic diagnoses. Cases (n = 78) submitted from 15 centers in 4 countries had the following diagnoses: fibroma (n = 30), rhabdomyoma (n = 14), malignant tumor (n = 12), hemangioma (n = 9), thrombus (n = 4), myxoma (n = 3), teratoma (n = 2), and paraganglioma, pericardial cyst, Purkinje cell tumor, and papillary fibroelastoma (n = 1, each). Reviewers who were blinded to the histologic diagnoses correctly diagnosed 97% of the cases but included a differential diagnosis in 42%. Better image quality grade and more complete examination were associated with higher diagnostic accuracy. Cardiac MRI can predict the likely tumor type in the majority of children with a cardiac mass. A comprehensive imaging protocol is essential for accurate diagnosis. However, histologic diagnosis remains the gold standard, and in some cases malignancy cannot be definitively excluded on the basis of cardiac MRI images alone.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2011.05.027