Multisequence cardiac MRI tissue characterization of cardiac masses: a retrospective cohort study

Cardiac masses comprise diverse neoplastic and non-neoplastic lesions requiring precise non-invasive evaluation. This study evaluates the diagnostic performance of multiparametric Cardiac magnetic resonance (CMR) using T1/T2 mapping, first-pass perfusion, and late gadolinium enhancement. We retrospectively analyzed 120 patients with histopathologically confirmed cardiac masses. The CMR protocol included cine imaging, T1/T2-weighted sequences, native T1/T2 mapping, perfusion, and LGE. Lesions were categorized as benign, primary/secondary malignant, or pseudotumors. The cohort included primary benign tumors (n = 52), thrombi (n = 21), secondary malignancies (n = 17), and primary malignancies (n = 16). Myxoma was the most frequent tumor (n = 27). Global chi-square tests showed that myxomas more often had high native T1/T2 and heterogeneous LGE compared with the overall cohort (p = 0.015, 0.002, 0.0002). Fibromas showed low T2 and homogeneous LGE (p = 0.201, 0.008), while lipomas exhibited low T1, high T2, and absent enhancement (p = 0.288, 0.464, 0.190). Thrombi displayed low native T1/T2 without enhancement (p = 0.008, 0.005, 0.001), whereas cysts showed high T1/T2 without enhancement (p = 0.004, < 0.0001, 0.018). Thrombi differed from benign tumors across T1, T2, and LGE (p = 0.004, < 0.001, < 0.001). Benign and malignant tumors significantly differed only in native T1 values (p = 0.045). High native T1 identified malignancy with 81.5% sensitivity; T2 and LGE sensitivities were 74.1% and 88.9%, respectively. For thrombi, low T1/T2 and absent LGE yielded sensitivities of 71.4%, 66.7%, and 81.0%, with specificities of 79.1–85.1%. Multiparametric CMR provides accurate, non-invasive differentiation of cardiac masses, significantly enhancing diagnostic confidence and clinical management.

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