Evaluation of cardiac masses by CMR—strengths and pitfalls: a tertiary center experience

Cardiovascular magnetic resonance (CMR) imaging is often considered the reference method to assess cardiac tumors. However, little data exists concerning the effectiveness of CMR for the accurate diagnosis of cardiac masses. We sought to understand the diagnostic value of CMR for evaluation of suspected cardiac mass. A total of 249 consecutive CMR cases performed at a single center from January 2005 to June 2013 for evaluation of masses found on echocardiography or computed tomography (CT) were included. All the clinical data and imaging features of these patients were retrospectively reviewed and medical records were verified for follow up care. More than half of the patients referred for evaluation of masses found at echocardiography or CT were found to have no evidence of mass by CMR. CMR correctly differentiated between thrombus and myxoma in 88.4 % cases. Malignant masses were accurately diagnosed on CMR. However, CMR missed or misdiagnosed a few cases of benign masses. Diagnosing cardiac masses remains an important use for imaging, despite technical difficulties with current imaging modalities. CMR can play a key role in confirming presence or absence of a mass. Additionally, in the presence of a mass, CMR can provide accurate differentiation of pseudomasses, benign and malignant masses. However, the limitations of CMR must be recognized.     

Computed tomography of renal masses

Computed tomography (CT) has provided a valuable imaging modality for the study of renal masses. Simple cysts are the most common of renal masses, and they are usually readily differentiated by CT from the wide variety of solid tumors that affect the kidneys. This article describes the CT technique which is used for evaluation of renal masses; the CT appearances of such renal tumors as renal cell carcinoma, renal pelvic carcinoma, lymphoma, oncocytoma, and angiomyolipoma and the use of CT in the staging of malignant renal tumors. The CT findings in various renal cystic diseases are also described. The role of CT for evaluating renal masses in relation to such other imaging techniques as sonography and angiography is discussed.     

罕见直肠肛管恶性肿瘤的临床与影像学诊断

【目的】探讨罕见直肠肛管恶性肿瘤的临床影像学表现。【方法】报道罕见直肠肛管恶性肿瘤15例．包括非何杰金氏淋巴瘤3例．平滑肌肉瘤9例，脂肪肉瘤2例，恶性黑色素瘤1例．15例中12例做了CT检查，9例进行了气钡灌肠检查。【结果】气钡灌肠示该类肿瘤主要表现为直肠下端或肛管隆起性病变．肠腔明显狭窄．可伴不规则龛影．肉瘤常较大．而恶性淋巴瘤常表现多发。CT表现为直肠或肛管肠壁增厚或局部肿块，肉瘤肿块常较大，多伴更低密度坏死区。邻近组织或器官可受累及。【结论】罕见直肠与肛管恶性肿瘤常用影像学检查方法为气钡灌肠与CT．其表现仅具有相对性特征。     

腮腺恶性肿瘤临床与影像学分析

目的：探讨腮腺恶性肿瘤的临床及影像表现。方法回顾性分析经临床病理证实的50例腮腺恶性肿瘤的临床资料,并对其中有影像资料的18例患者（3例超声,3例CT,3例MRI,6例行CT及超声,2例行MRI及超声,1例行CT和MRI）肿瘤位置、形态、大小、边界、内部结构、强化或血流情况等特征进行分析。结果18例腮腺恶性肿瘤表现为腮腺区结节或肿块,无痛性肿块16例,疼痛2例。肿块类圆形或椭圆形13例,肿块为实性16例,囊实性2例。部分不规则,边界清楚10例、不清晰8例。肿块可跨深浅叶（8例）,可位于浅叶（10例）。单发17例,1例淋巴瘤多发。肿块多强化明显或血流丰富（15例）。肿块大小范围较大。肿块多有分叶征（15例）。转移瘤多发、常囊变坏死、边界不清。恶性淋巴瘤常多发、均质、边界清。结论腮腺恶性肿瘤有一定影像特征,但同良性肿瘤特征有重叠;合并淋巴结转移、肿瘤分叶且边界不清或侵犯周围结构、明显强化且不均匀或伴明显坏死等对腮腺恶性肿瘤的诊断有重要价值。     

超声心动图对心腔及心包恶性肿瘤的诊断分析

目的：分析病理诊断为心脏恶性肿瘤患者的超声影像特征,以提高诊断恶性肿瘤的准确性。方法：回顾性分析心脏恶性肿瘤患者的超声改变及病理结果。结果：16例心脏恶性肿瘤包括原发恶性肿瘤8例,转移性肿瘤8例。结论：超声诊断心脏恶性肿瘤敏感性,特异性为81．25％、100％,左心系统及心包恶性肿瘤易误诊或漏诊,尤应予以重视。     

The usefulness of delayed contrast-enhanced cardiovascular magnetic resonance imaging in differentiating cardiac tumors from thrombi in stroke patients

The objectives of this study were to evaluate the diagnostic value of delayed-enhancement cardiovascular magnetic resonance (DE-CMR) imaging in differentiating cardiac tumors from thrombi in patients with suspected cardio-embolic stroke. Two radiologists blinded to the study protocol retrospectively evaluated MR images of 22 patients (12 men and 10 women; mean age 59.2 years) that had recently experienced a stroke and undergone CMR. Six cardiac tumors and 16 thrombi were confirmed on surgery or follow-up examinations. On DE-CMR, a tumor was defined as an intracardiac mass showing post-contrast enhancement, and a thrombus was defined as an intracardiac mass showing black signal intensity (SI) without post-contrast enhancement. The mean SI in regions of interest in the normal myocardium and cardiac mass were measured using cine-CMR and DE-CMR. Visual assessment of enhancement characteristics of cardiac masses on DE-CMR could accurately differentiate cardiac tumors from thrombi in all cases. On cine-CMR, the mean SI ratios for tumors and thrombi were 1.45 ± 0.45 (range, 1.12-2.16) and 1.39 ± 0.33 (range, 0.87-2.09), respectively (P = 0.745). On DE-CMR, the mean SI ratios for tumors and thrombi were 5.65 ± 2.96 (range, 2.98-9.92) and 1.06 ± 0.43 (range, 0.67-1.95), respectively (P < 0.001). DE-CMR is a non-invasive modality for detecting intra-cardiac mass can differentiate tumors from thrombi in cardio-embolic stroke patients.     

Primary osseous tumors of the foot and ankle

Primary bone tumors involving the foot or ankle may be imaged, because they are symptomatic or may be found incidentally on imaging studies investigating other causes of pain or swelling. As an uncommon location for malignant bone tumors, lesions within the foot and ankle are subject to misdiagnosis. This article reviews the most commonly encountered primary benign and malignant osseous neoplasms that affect the foot and ankle, emphasizing their characteristic radiologic and MR imaging features to aid in appropriate patient management.     

Magnetic resonance imaging of adnexal masses

Adnexal masses are common in women of all ages. A range of physiological and benign ovarian conditions that develop in women, especially in the reproductive age, and adnexal malignancies can be evaluated with magnetic resonance imaging (MRI). Management of women with adnexal masses is frequently guided by imaging findings; therefore, precise characterization of adnexal pathology should be performed whenever possible. Magnetic resonance imaging is useful in characterization of adnexal masses that are not completely evaluated by ultrasound because it can provide additional information on soft tissue composition of adnexal masses based on specific tissue relaxation times and allows multiplanar imaging at large field of view to define the origin and extent of pelvic pathology. The patients most likely to benefit from MRI are pregnant women and those who are premenopausal and have masses that have complex features on ultrasound but do not have raised cancer antigen 125 tumor marker levels. The overlap in imaging appearance among different cell type malignancies makes it difficult to predict exact histology based on MRI appearance; however, MRI has a high accuracy in differentiating benign from malignant masses. Teratomas, endometriomas, simple and hemorrhagic cysts, fibromas, exophytic or extrauterine fibroids, and hydrosalpinges can be diagnosed with high confidence.In this article, the authors review the histopathologic background and MRI features of adnexal masses and discuss the role of MRI in the differentiation of benign from malignant adnexal pathologies.     

2-Deoxy-2-[F-18]fluoro-D-glucose-Positron Emission Tomography in Characterization of Solid Renal Masses

The present study was aimed to evaluate the ability of 2-deoxy-2-[F-18]fluoro-d-glucose (FDG)-positron emission tomography (PET) in characterization of solid renal masses visualized by computed tomography (CT)/magnetic resonance imaging (MRI) in patients with suspected or known malignancies. Methods Twenty-eight solid renal masses (20 unilateral and four bilateral, Size ranges, 1.0–8.4 cm) were evaluated in 24 patients. The results were correlated with histopathology in 15 patients, and clinical follow-up and conventional imaging in all patients. Results Of the 28 solid renal masses, 10 were primary (nine malignant, one benign) and 18 were metastatic renal tumors. FDG-PET accurately depicted 23 of 27 (85%) malignant renal masses. Of the 10 primary renal tumors, FDG-PET was true positive in eight of nine (89%), true negative in one and false negative in one. The maximum and average standardized uptake values (SUVs) for FDG positive primary renal malignant tumors were 7.9 ± 4.9 and 6.0 ± 3.6, respectively. In addition to the characterization of primary tumors, FDG-PET was valuable in primary staging and altered treatment in 30% of patients (three of 10). Of the 18 metastatic renal masses, FDG-PET was positive in 15 (83%) masses. The maximum and average SUVs of metastatic renal masses were 6.1 ± 3.4 and 4.7 ± 2.8, respectively. There was no significant difference in maximum and average SUVs between primary and metastatic renal masses (p = 0.3 and p = 0.3). Conclusion Despite the physiological excretion of FDG by the kidneys, FDG-PET can be employed effectively in characterization of solid renal masses in patients with suspected or known malignancies. We propose that FDG-PET could be useful as a complimentary modality to conventional imaging in these patients.     

The gamut of primary retroperitoneal masses: multimodality evaluation with pathologic correlation

The retroperitoneum is a large space where primary and metastatic tumors grow silently before clinical signs appear. Neoplastic retroperitoneal diseases may be solid or cystic, primary or secondary and range from benign to aggressive in behavior. Retroperitoneal neoplasms are notable for their widely disparate histologies. The solid primary retroperitoneal neoplasms are extremely uncommon and can be classified based on their tissue of origin into three main categories: mesodermal tumors, neurogenic tumors, and extragonadal germ cell tumors. These tumors can grow to a large size before clinical symptoms occur or become palpable. When symptoms do occur, they are nonspecific. The majority of these masses are malignant and imaging plays a pivotal role in the detection, staging, and pre-operative planning. Benign and malignant masses should be distinguished whenever possible to avoid unnecessary surgical procedures. Macroscopic fat, calcification, necrosis, vascularity, and neural foraminal widening are common imaging features helping for tumor differentiation. Meticulous cross-sectional imaging can triage the patient to the most appropriate therapy. Tumor morphology dictates imaging character, and biologic activity is reflected by positron emission tomography (PET). Complete surgical excision with tumor free margins is essential for long-term survival. Biopsy should be performed in consultation with surgical oncology to avoid complicating curative surgery. This pictorial essay illustrates the spectrum of multidetector computed tomography (MDCT) imaging findings in common and uncommon primary retroperitoneal masses, with an emphasis on cross-sectional imaging features for an adequate tumor characterization and staging.

     

超声造影在肝恶性肿瘤介入治疗疗效评估中的应用价值

目的观察肝恶性肿瘤介入治疗后超声造影表现,并与其他影像学方法比较,评估其对介入治疗疗效判定的临床应用价值。方法评估介入治疗疗效66例次,病灶78个,介入治疗后均行超声造影检查及同期CT/MRI/DSA检查(超声造影前后2周内),包括经肝动脉插管栓塞化疗(TACE)38例次46个病灶,射频(RF)消融治疗13例次15个病灶,经皮乙醇注射(PEI)治疗15例次17个病灶。超声造影显像将病灶分为有增强和无增强两类。结果介入治疗后,超声造影显示44个病灶(56.4%)动脉相局部增强区,34个病灶无增强。同期CT/MRI/DSA诊断41个病灶(52.6%)有肿瘤复发/残存,以后者为对照,实时谐波超声造影评估肝恶性肿瘤介入治疗疗效的敏感性为87.8%,特异性为78.4%,符合率为83.3%。TACE、RF、PEI三种肝脏恶性肿瘤治疗方式中,超声造影对TACE治疗后疗效评估的敏感性、特异性及符合率最高,分别为92.0%,85.7%,89.1%。结论超声造影可以作为肝脏恶性肿瘤介入治疗疗效评估的可靠方法,且更适于TA-CE治疗后的疗效评价。     

MR imaging of tumors and tumor-like lesions of the hip

In conclusion, a wide variety of tumors and tumor-like conditions have a predilection for the hip. The imaging evaluation of these lesions begins with radiographs. Radiographs can depict the extent of disease; any characteristic calcifications; and osseous changes, such as remodeling,periosteal reaction, or destruction. MR imaging has emerged as the preferred imaging modality of choice for evaluating osseous and soft tissue masses of the hip by providing information for diagnosis and staging. The MR imaging signal characteristics and enhancement patterns of malignant and benign hip tumors permit specific diagnoses in some cases. Synovial-based tumor-like processes of the hip can be characterized by MR signal characteristics, such as the hemosiderin within PVNS or the cartilage within synovial chondromatosis. Finally, MR imaging can serve to exclude underlying osseous or soft tissue tumors when radiographs display aggressive features of tumor-like processes.     

CT、MRI诊断咀嚼肌间隙肿瘤

目的 观察咀嚼肌间隙(MS)肿瘤的CT、MRI表现及继发肿瘤累及MS的途径.方法 57例MS肿瘤患者,2例接受CT检查,17例接受MR检查,38例同时接受CT和MR检查.回顾性分析57例影像学表现.结果 7例原发MS肿瘤,6例原发良性肿瘤边界清楚、相邻咀嚼肌和骨质受压,1例原发恶性肿瘤边界不清伴骨质破坏.50例继发肿瘤,14例颅底、眼眶肿瘤经眶下裂累及MS,7例泪腺腺样囊性癌、1例白血病破坏眼眶外壁侵犯MS,2例视网膜母细胞瘤跳跃性转移至MS,9例鼻腔、鼻窦、鼻咽肿瘤经蝶腭孔累及MS,15例上颌窦肿瘤、1例鼻腔筛窦肿瘤破坏上颌窦后壁侵犯MS,1例翼腭窝肿瘤直接侵犯MS.20例继发良性肿瘤多边界清楚、咀嚼肌受压或萎缩、相邻骨质受压,30例继发恶性肿瘤多边界不清、上颌窦后间隙消失、翼突骨质破坏.结论 CT和MRI能清晰显示MS肿瘤的形态、边界、范围、相邻结构的异常改变,对原发肿瘤的诊断、继发恶性肿瘤的临床分期有重要价值.     

恶性卵巢子宫内膜样肿瘤的影像学评价

目的探讨恶性卵巢子宫内膜样肿瘤的CT及MRI诊断价值。方法回顾性分析10例经手术病理证实的恶性卵巢子宫内膜样肿瘤的cT或MRI表现。结果10例恶性卵巢子宫内膜样肿瘤13个肿块．7例为单侧（左侧4例,右侧3例）,3例为双侧（左右各一）。10例中卵巢子宫内膜样腺癌7例;恶性Maller混合瘤2例（1例为双侧,1例合并子宫内膜腺癌）;卵巢子宫内膜样间质肉瘤合并子宫内膜异位症1例。平扫示肿瘤多为类圆形、分叶状实性为主肿块,囊变多见,增强扫描后肿瘤实性部分不均匀强化,部分病例边缘明显强化,呈多囊状环形强化6例。结论恶性卵巢子宫内膜样肿瘤的影像表现具有一定特征性,CT和／或MR可明确定性,对病理诊断有一定的提示作用。     

23例心脏肿瘤的临床特点与外科诊治分析

【目的】探讨23例心脏肿瘤临床特点,总结外科诊断和治疗的经验。【方法]2002年6月至2009年12月手术治疗23例心脏肿瘤患者,其中心脏粘液瘤13倒,原发性心脏恶性肿瘤4例,右心下腔静脉平滑肌瘤5例,肝癌右心房转移性癌栓1例。所有病例术前均查心脏彩超,怀疑恶性者行CT或核磁共振检查,除1例患者因右房肿瘤广泛侵犯右房室环及心包而仅做活检外,其余22例均在全麻低温体外循环辅助下行肿瘤切除术。【结果】住院期间全组病例无死亡,13例粘液瘤患者平均随访2年无复发转移。5例心脏恶性肿瘤患者中除1例因患者无法联系外,余4例均在2年内死亡。右心下腔静脉平滑肌瘤患者中有1例于术后一年半经MRI证实复发。【结论】原发性心脏良性肿瘤以黏液瘤多见,彻底切除肿瘤是防止复发的关键。心脏恶性肿瘤预后差,早期手术治疗并辅以综合治疗可望改善预后。     

Pediatric head and neck masses

Most neck masses in the pediatric head and neck region are benign. Congenital, developmental, and inflammatory lesions make up most of the masses in the pediatric head and neck. For example, neck masses due to inflammatory lymphadenitis are common in children because of the frequency of upper respiratory tract infections. Although many of the malignant tumors in children are found in the head and neck, they account for only a small portion of the neck masses. The choice of the imaging modality is based on a number of factors, several of which are unique to the pediatric population. Although the bulk of disease entities are adequately evaluated by CT, MRI can provide additional vital information in many cases. MRI provides better soft tissue characterization than CT, has multiplanar capabilities. In this article, we will attempt to provide an overview of conditions that present as neck masses.     

腹内型隐睾恶性肿瘤的影像学表现

目的探讨腹内型隐睾恶性肿瘤的影像学特点。方法回顾性分析6例经手术及病理证实的腹内型隐睾恶性肿瘤的临床表现、CT、超声及MRI特征。结果6例行CT扫描,呈边界清楚的软组织肿物,强化不均匀。4例行超声检查,均呈不均匀低回声。1例行MRI检查,信号不均匀,呈不均匀强化。3例伴有腹膜后淋巴结肿大。全部病例病理结果均为精原细胞瘤。结论腹内型隐睾恶性肿瘤影像学表现有一定的特征性,影像医生应该提高对该病的认识。     

Cardiovascular magnetic resonance of primary tumors of the heart: A review.

Overall, the prevalence of primary cardiac neoplasms is approximately 0.3% and these masses should be distinguished from the myriad of other primary and secondary processes that can occur in the heart. Tumors within, attached to, or near the heart can cause direct cardiac damage, can result in thrombus formation, can compromise blood flow and can embolize distally. Hence, proper diagnosis is clinically important. It has been suggested that cardiovascular magnetic resonance (CMR) imaging is a useful tool for diagnosing and characterizing cardiac tumors. In this report, we present a case example of a patient with a large, mobile right atrial myxoma imaged by CMR with results of histopathologic analysis after excision. We also demonstrate the utilization of CMR for characterization of cardiac lesions, review the basic characteristics of primary cardiac neoplasms, provide an overview of published cases describing use of CMR, and give suggested guidelines for imaging of cardiac masses with emphasis on diagnosis of cardiac tumors. CMR is an important technique for diagnosing and characterizing cardiac tumors.     

The role of echocardiography in diagnosing space-occupying lesions of the heart

In contrast to primary cardiac tumors, which are less frequent and mostly benign in nature, the majority of intracardiac tumors are metastatic lesions. Cardiac ultrasound has evolved enormously since its emergence in the 1950s and is presently the modality of choice for imaging space-occupying lesions of the heart; it provides high quality, real-time images that are extremely valuable in the evaluation of cardiac masses. Although transthoracic echocardiography is an excellent initial diagnostic technique to evaluate and diagnose cardiac masses, transesophageal echocardiography provides superior image resolution and better visualization of cardiac masses in patients with suboptimal transthoracic echocardiography studies. Computed tomography and magnetic resonance imaging are additional tools used for cardiac imaging and may provide useful information in addition to that obtained by echocardiography, especially when the images obtained by the latter are suboptimal.     

Multimodality imaging of small bowel neoplasms

Although the small intestine accounts for over 90% of the surface area of the alimentary tract, tumors of the small intestine represent less than 5% of all gastrointestinal tract neoplasms. Common small bowel tumors typically are well evaluated with cross-sectional imaging modalities such as CT and MR, but accurate identification and differentiation can be challenging. Differentiating normal bowel from abnormal tumor depends on imaging modality and the particular technique. While endoscopic evaluation is typically more sensitive for the detection of intraluminal tumors that can be reached, CT and MR, as well as select nuclear medicine studies, remain superior for evaluating extraluminal neoplasms. Understanding the imaging characteristics of typical benign and malignant small bowel tumors is critical, because of overlapping features and associated secondary complications.