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العنوان
THE ROLE OF MULTI-PARAMETRIC
CARDIAC MRI IN charCTERIZATION OF
CARDIAC MASSES /
المؤلف
SALAMA,FATMA MAGDY MOHAMED.
هيئة الاعداد
باحث / FATMA MAGDY MOHAMED SALAMA
مشرف / HANAA ABDEL-KADER AHMED
مشرف / MOHSEN GOMAA HASAN
مشرف / AHMED SAMIR IBRAHIM
تاريخ النشر
2015
عدد الصفحات
196p.:
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
الأشعة والطب النووي والتصوير
تاريخ الإجازة
1/1/2015
مكان الإجازة
جامعة عين شمس - كلية الطب - الاشعة التشخصية
الفهرس
Only 14 pages are availabe for public view

from 196

from 196

Abstract

Cardiac tumors, either benign or malignant, are rare. Malignant
tumors have a poorer prognosis than benign tumors; however both
are associated with significant morbidity in cases of delayed
management. So the correct identification and differentiation
between the cardiac masses are essential for better therapeutic
planning and better prognosis.
Definite diagnosis of cardiac masses is done by biopsy and
histopathology; however, the invasiveness of cardiac biopsy may
lead to multiple complications up to cardiac tamponade and death,
also, most cardiac masses are not amenable to percutaneous or
catheter biopsy. Here it comes the crucial role of cardiac imaging
in evaluation of cardiac masses.
Multiple imaging modalities including echocardiography,
MDCT and CMR, are used in evaluation and characterization of
cardiac masses. Echocardiography is the primary imaging modality;
however, in most of cases it is unable to reach final diagnosis
owing to incomplete cardiac evaluation due to limited field of view
and soft tissue resolution as well as inadequate evaluation of
extracardiac structures.
Cardiac MRI has gained more acceptance to evaluate suspected
cardiac tumors owing to its non-invasive nature and lack of
ionizing radiation exposure as well as its high temporal resolution
providing better tissue characterization. So, CMR is considered
nowadays the gold standard in assessment of suspected cardiac
tumor.
We conducted a study to elucidate the role of multi-parametric
CMR for better characterization of cardiac masses. Our diagnosis
was made depending on the MR features as described in literatures as well as the clinical data and follow up. We aimed to differentiate
between true and pseudo tumors as well as benign and malignant
lesions so as to reach an accurate diagnosis that was accepted
clinically and fulfilled the data needed for pre-therapeutic planning
without need of the unnecessary invasive biopsy.
In our study, two radiologists interpreted and analyzed
separately the imaging data of 27 patients who met the inclusion
criteria and performed CMR at MRI unit in Ain Shams University
Educational Hospital and Misr Radiology center in Cairo. Only the
agreed diagnosis of both radiologists was considered in our study.
The remaining was two cases that either showed disagreement
between the radiologists’ final diagnoses or both radiologists failed
to give the final diagnosis and needed further investigation.
Thrombus is considered the most common non neoplastic
cardiac mass (pseudo-tumor). Pseudo-tumors are characterized by
their regular marginal outline and the absence of enhancement in
delayed post contrast study as well as their preferential location in
the right atrium and least affection in the right ventricle.
The most common benign tumor in adult is myxoma and in
children is rhabdomyoma. The benign cardiac masses are
characterized by their relative small size, regular marginal outline,
localized pattern of growth, and absence of pericardial infiltration
while malignant masses are characterized by their relative large
size, irregular marginal outline, variable enhancement in delayed
post contrast study, diffuse infiltrative pattern of growth, presence
of pericardial infiltration and / or pericardial effusion, infiltration
of the great vessels as IVC as well as presence of extra cardiac
masses.
CMR has not only the ability to differentiate between benign
and malignant lesions but also has the ability to differentiate
between different types of benign tumors in most of cases by determination the location of the cardiac mass, its mobility,
presence of pedicles and the variable MR signal intensity in
different pre and post contrast sequences. In contrast to the
malignant lesions, CMR shows a difficulty in the differentiation
between different types of malignant lesions and usually needs
histopathological correlation. However CMR shows a great value
in determining the extent of the malignant lesions that is needed
before planning the therapeutic management.
Some promising techniques such as DWI, DTI and MRS in
cardiac imaging are expected to add more valuable information
helping in better characterization of cardiac masses, and their role
should be verified in future researches.