title: Cardiac MRI-based multi-modality imaging in clinical decision-making: Preliminary assessment of a management algorithm for patients with suspected cardiac mass.
abstract: BACKGROUND
  Cardiac masses are rare with high morbidity and mortality that challenging the management. The purpose of this study was to evaluate the potential role of cardiac-MRI based multi-modality imaging in the clinical decision-making for patients with cardiac mass.
  
  
  METHODS
  From November 2011 to May 2014, 59 consecutive patients (33 females; mean age, 48.2 ± 21.1 [range, 0.6-85] years) with suspected cardiac mass were enrolled in this prospective single center study, underwent MRI based multi-modality imaging and were followed up for survival status. Management strategy (surgery, chemotherapy or observation) was based on patient's clinical status and cardiac mass imaging characteristics (location, morphology, hemodynamics, embolization risk, metastasis, and resectability).
  
  
  RESULTS
  Using cardiac MRI, 39 patients were diagnosed with intra-cardiac neoplasm (28 benign, 11 malignant) and 20 with pseudo-tumors (13 thrombi, 4 cysts and 3 fat infiltration); 34 masses (23 neoplasms, 11 pseudo-tumors) were eligible for surgical removal, and 4 underwent PET-CT scan to further delineate characteristics and metastasis. Pathological examination revealed high accuracy of cardiac MRI in differentiating benign from malignant tumors (96%), and neoplasm from pseudo-tumors (100%). As for the 16 patients with cardiac neoplasm not surgically treated, the 9 with "benign" masses as per MRI-based multimodality imaging survived during follow-up, while all 7 with "malignancy" died; the 9 with pseudo-tumors not surgically treated also survived with good condition. The median follow-up period is 2 years (10 days-3 years).
  
  
  CONCLUSIONS
  Cardiac MRI based multimodality imaging appears useful for risk stratification and clinical decision making for patients with suspected cardiac mass.
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital, Sichuan University, PR China.
authors.forename: Da
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital, Sichuan University, PR China.
authors.forename: Senlin
authors.initials: S
authors.lastname: Yin
authors.affiliation: Department of Radiology, West China Hospital, Sichuan University, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, PR China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, PR China.
authors.forename: Dan
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital, Sichuan University, PR China.
authors.forename: Ke
authors.initials: K
authors.lastname: Lin
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital, Sichuan University, PR China.
authors.forename: Qi
authors.initials: Q
authors.lastname: An
authors.affiliation: Department of Radiology, West China Hospital, Sichuan University, PR China.
authors.forename: Jiayu
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, PR China. Electronic address: chenyucheng2003@163.com.
authors.forename: Yucheng
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D005260:Female; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Cardiac MRI; Cardiac mass; Clinical decision making; Multimodality imaging; Survival