Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging.
OBJECTIVE
We investigated the usefulness of echocardiographic contrast perfusion imaging in differentiating cardiac masses.


BACKGROUND
Two-dimensional echocardiography is the primary diagnostic modality for cardiac masses. However, differentiation between the different types of cardiac masses may be difficult at times. We hypothesized that echocardiographic contrast perfusion imaging would differentiate the neo-vascularization of malignancies from the avascularity of thrombi and the sparse vascularity of stromal tumors.


METHODS
Sixteen patients with cardiac masses underwent power-modulation imaging after echocardiographic intravenous contrast administration. Pixel intensities in the mass and an adjacent section of myocardium were analyzed visually and by dedicated software. All masses had a pathologic diagnosis or resolved after anticoagulation. In a subset of patients, video-intensity curves of contrast replenishment in the mass and myocardium over time were generated. The post-impulse steady-state pixel intensity (A) and initial rate of contrast replenishment after impulse (beta) were compared with an index of blood vessel area on pathology.


RESULTS
In seven of 16 patients, contrast enhancement resulted in greater pixel intensity in the mass than in the adjacent myocardium. All of these masses were classified pathologically as malignant (n = 6) or benign and vascular (n = 1). Nine masses demonstrated decreased pixel intensity, compared with the myocardium, and were diagnosed pathologically as myxomas (n = 2) or thrombi (n = 5), or they resolved with anticoagulation (n = 2). For the subset of patients, beta correlated with the vessel area index (r = 0.60).


CONCLUSIONS
Echocardiographic contrast perfusion imaging aids in the differentiation of cardiac masses. Compared with the adjacent myocardium, malignant and vascular tumors hyper-enhanced, whereas stromal tumors and thrombi hypo-enhanced.
Kirkpatrick
James N
JN
Adult Noninvasive Cardiac Imaging Laboratories, Section of Cardiology, University of Chicago, Chicago, Illinois 60637, USA.
Wong
Tiffany
T
Bednarz
James E
JE
Spencer
Kirk T
KT
Sugeng
Lissa
L
Ward
R Parker
RP
DeCara
Jeanne M
JM
Weinert
Lynn
L
Krausz
Thomas
T
Lang
Roberto M
RM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D003287:Contrast Media; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods; D005260:Female; D006338:Heart Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000000981:diagnostic imaging*; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy
D000925:Anticoagulants; D003287:Contrast Media