Home » Resources » Scanning Info - Masses

Masses - Cardiac and paracardiac masses, including thrombi

a) SCMR official document standardized acquisition guidelines – relevant extract

1. LV structure and function module
2. T1 weighted fast spin echo – slices through the mass and surrounding structures (number of slices depends on size of the mass)
3. T2 weighted fast spin echo with fat suppression (optional – without fat suppression) – through the mass and surrounding structures as above. See nonischemic cardiomyopathies for sequence details.
4. First pass perfusion module with slices through mass
5. Repeat T1 weighted turbo spin echo with fat suppression
6. (optional) Repeat selected steady state free precession cine images post-contrast
7. Late gadolinium enhancement module – note that TI to null the mass may be different than for myocardium.

b) SCMR official document reporting recommendations – relevant extract

The standard report should consist of the following components:
Myocardial mass description:
Absent
Present
Location (pericardial, myocardial, valve relationship, chamber relationship)
Size (cross-sectional dimensions)
T1 signal intensity (homogeneous, heterogeneous, hyper, iso or hypo intense myocardium/ or chest wall (specify reference tissue)
T1 fat sat images signal intensity (if performed) (homogeneous, heterogeneous,hyper, iso or hypo intense to myocardium/ or chest wall (specify reference tissue)
T2 signal intensity (homogeneous, heterogeneous, hyper, iso or hypo intense to myocardium/ or chest wall (specify reference tissue)
STIR signal intensity
Perfusion pattern (if perfusion performed)
Late gadolinium enhancement pattern on static/ delayed images (if gadolinium administered)
Relationship to myocardium/ pericardium, mediastinum
Margins (e.g., smooth, irregular, infiltrating, pediculated)
Cine CMR appearance (pedunculated, motion with myocardium/ pericardium)
Myocardial function (if performed, qualitative or quantitative as appropriate)
Pericardial abnormalities if present (pericardial thickness should be reported along with determination of the presence or absence of a pericardial effusion)

c) Standardized web based images

Not yet done

d) Case of the Week example(s)

Number 10-01: Myofibroblastic tumor of the right atrium in a 2-year old boy
History: A 2 year-old male with a history of one week febrile illness and cough was evaluated by his pediatrician

Number 09-16: A large and mysterious mass in the LV
History: A 59 y/o female with history of breast CA s/p right lumpectomy and ovarian CA was referred for CMR

Number 09-09: Left Atrial Appendage Clot and Atrial Fibrillation
History: Atrial appendage thrombus post thoracoscopic atrial appendage amputation imaged with CMR.

Number 06-01: Left Atrial Myxoma
History: An 80 year old men presented with dyspnea. Echo showed a LA mass. Cine CMR (left) showed a large (7x7x4cm) tumor attached to the fossa ovalis, prolapsing through the mitral valve. Signal intensities: low T1 and high T2 (middle, top and bottom) were also compatible with myxoma, subsequently confirmed at surgery (right). The patient was discharged 6 days after surgery.

Number 06-04: Thrombus or tumor?
History: An 84 year old women presented breathless. Earlier in the year, she had undergone coronary artery bypass from which she had made a full recovery. Echocardiography demonstrated a left atrial mass, of uncertain aetiology.

Number 07-10: Tumor or Thrombus?
History: 61 year old male, known renal cell carcinoma with renal venous thrombosis.

Number 07-18: Right Atrial Tumour - or not?
History: An incidental mass was identified in the right atrium of a middle aged female on pre-operative trans thoracic echocardiography (top left). CMR requested for further characterization.

Number 08-03: Primary Pericardial Echinococcosis
History: A 47 year male previously admitted with a severe pericardial effusion which was drained and an associated left pleural effusion. Subsequently referred for a CMR scan with as a structure “like a cyst” was noted near the heart on echocardiography.

Number 08-11: CMR for RA Mass characterization
History: A 37 yr female had an echocardiogram for chest pain showing a possible mass in the right atrium. CMR was performed to further characterise this.

Number 08-22: A Segmented thoracic mass
History: A 32 yrs old man was referred for assessment of iron loading by measurement of cardiac T2*. Past medical history of transfusion dependent thalassaemia (thalassemia) major and chronic iron chelation therapy.

e) Expert opinion – ‘How we do’

No 'How I do' currently done.

f) Relevant Online Talks

Free talks

Masses
By James C. Moon - The Heart Hospital, London
Recorded at SCMR 2010

Cardiac Masses
By Gunnar Lund
Recorded at EuroCMR 2008

g) Relevant papers (starting point):

Hoffmann U, Globits S, Schima W, Loewe C, Puig S, Oberhuber G, Frank H. Usefulness of magnetic resonance imaging of cardiac and paracardiac masses. Am J Cardiol. 2003;92:890-5