Download PDF
Rofo 2005; 177(9): 1205-1218
DOI: 10.1055/s-2005-858489
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Herztumoren: Magnetresonanztomographie und Mehrschicht-Spiral-CT

Heart Tumors: Magnetic Resonance Imaging and Multislice Spiral CTG. A. Krombach1 , E. Spuentrup1 , A. Buecker1 , A. H. Mahnken1 , M. Katoh1 , Y. Temur1 , C. B. Higgins1 , R. W. Günther1
  • 1Klinik für Radiologische Diagnostik, Universitätsklinikum Aachen
Further Information

Publication History

Publication Date:
25 August 2005 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Untersuchung bei Verdacht auf Herztumoren ist zunächst die Domäne der Echokardiographie. Diese Methode ist jedoch durch ihr begrenztes Messfeld und das bei manchen Patienten unzureichende Schallfenster eingeschränkt. Die Magnetresonanztomographie (MRT) und seit Einführung der Mehrschicht-Spiralcomputertomographie (MSCT) auch dieses Verfahren erlauben die detaillierte Darstellung von intra- und parakardialen Tumoren sowie die Bestimmung ihrer Ausdehnung und ihres Einflusses auf die Herzfunktion. Primäre benigne und maligne Herztumoren weisen in der MRT einige charakteristische Merkmale auf, die die Differenzialdiagnose erheblich einengen und in manchen Fällen die eindeutige Diagnose erlauben. Viele dieser Merkmale werden auch in der Computertomographie (CT) deutlich. Die vorliegende Arbeit gibt einen Überblick über Untersuchungstechniken in den Schnittbildverfahren MRT und CT bei Verdacht auf eine kardiale Raumforderung und beschreibt das Erscheinungsbild von primären und sekundären Herztumoren und intrakardialen Thromben.

Abstract

Transthoracic echocardiography is usually the initial diagnostic test in patients with a suspected cardiac mass. However, this technique is restricted by its small field of views and insufficient acoustic window in some patients. Magnetic resonance imaging (MRI) and, since its introduction, multislice spiral computed tomography allow for detailed delineation of intra and pericardiac tumors, their extent, and their influence on cardiac function. Primary benign and malignant cardiac tumors have several characteristic features in MR imaging. Assessment of such features may narrow down the differential diagnosis or even allow for reliable diagnosis in selected cases. Many such features can also be assessed using MSCT. This article provides an overview of examination protocols of MRI and CT for cases in which a cardiac mass is suspected and describes the appearance of primary and secondary cardiac masses as well as intracavitary thrombi.

Key words

Cardiac masses - MRI, heart

Literatur

  • 1 Lam K Y, Dickens P, Chan A C. Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies.  Arch Pathol Lab Med. 1993;  117 1027-1031
    PubMedGoogle Scholar
  • 2 Edelman R R, Chien D, Kim D. Fast selective black blood MR imaging.  Radiology. 1991;  181 655-660
    PubMedGoogle Scholar
  • 3 Mahnken A H, Gunther R W, Krombach G A. Grundlagen der linksventrikulären Funktionsanalyse mittels MRT und MSCT.  Fortschr Röntgenstr. 2004;  176 1365-1379
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Hergan K, Schuster A, Mair M. et al . Normalwerte der Herzdurchmesser in der Cine-MRT.  Fortschr Röntgenstr. 2004;  176 1599-1606
    PubMedGoogle Scholar
  • 5 Gergely I, Neumann C, Dorffner R. Solitäre Karzinoidmetastase im Herzseptum: Erstdiagnose mittels CT.  Fortschr Röntgenstr. 2003;  175 859-860
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Blondeau P. Primary cardiac tumors - French studies of 533 cases.  Thorac Cardiovasc Surg. 1990;  38 (Suppl 2) 192-195
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 MacGowan S W, Sidhu P, Aherne T. et al . Atrial myxoma: national incidence, diagnosis and surgical management.  Ir J Med Sci. 1993;  162 223-226
    PubMedGoogle Scholar
  • 8 Carney J A. Carney complex: the complex of myxomas, spotty pigmentation, endocrine overactivity, and schwannomas.  Semin Dermatol. 1995;  14 90-98
    CrossrefPubMedGoogle Scholar
  • 9 Amano J, Kono T, Wada Y. et al . Cardiac myxoma: its origin and tumor characteristics.  Ann Thorac Cardiovasc Surg. 2003;  9 215-221
    Google Scholar
  • 10 Acebo E, Val-Bernal J F, Gomez-Roman J J. et al . Clinicopathologic study and DNA analysis of 37 cardiac myxomas: a 28-year experience.  Chest. 2003;  123 1379-1385
    CrossrefPubMedGoogle Scholar
  • 11 Dubois C L, Herijgers P. Imaging of a huge atrial myxoma.  Heart. 2003;  89 99
    CrossrefPubMedGoogle Scholar
  • 12 Maintz D, Gunia S, Baumgart P. et al . Acute myocardial infarction as the first manifestation of left atrial myxoma.  AJR Am J Roentgenol. 2004;  183 1838-1839
    PubMedGoogle Scholar
  • 13 Sakamoto H, Sakamaki T, Sumino H. et al . Production of endothelin-1 and big endothelin-1 by human cardiac myxoma cells.  Circ J. 2004;  68 1230-1232
    CrossrefPubMedGoogle Scholar
  • 14 Spuentrup E, Mahnken A H, Kuhl H P. et al . Fast interactive real-time magnetic resonance imaging of cardiac masses using spiral gradient echo and radial steady-state free precession sequences.  Invest Radiol. 2003;  38 288-292
    CrossrefPubMedGoogle Scholar
  • 15 Semelka R C, Shoenut J P, Wilson M E. et al . Cardiac masses: signal intensity features on spin-echo, gradient-echo, gadolinium-enhanced spin-echo, and TurboFLASH images.  J Magn Reson Imaging. 1992;  2 415-420
    PubMedGoogle Scholar
  • 16 Roberts-Thomson K C, Teo K S, Stuklis R. et al . Left atrial myxoma: magnet or echo?.  Intern Med J. 2004;  34 210-211
    CrossrefPubMedGoogle Scholar
  • 17 Grebenc M L, Rosado-de-Christenson M L, Green C E. et al . Cardiac myxoma: imaging features in 83 patients.  Radiographics. 2002;  22 673-689
    PubMedGoogle Scholar
  • 18 Masui T, Takahashi M, Miura K. et al . Cardiac myxoma: identification of intratumoral hemorrhage and calcification on MR images.  AJR Am J Roentgenol. 1995;  164 850-852
    PubMedGoogle Scholar
  • 19 Salanitri J C, Pereles F S. Cardiac lipoma and lipomatous hypertrophy of the interatrial septum: cardiac magnetic resonance imaging findings.  J Comput Assist Tomogr. 2004;  28 852-856
    PubMedGoogle Scholar
  • 20 Kaplan K R, Rifkin M D. MR diagnosis of lipomatous infiltration of the interatrial septum.  AJR Am J Roentgenol. 1989;  153 495-496
    PubMedGoogle Scholar
  • 21 Heyer C M, Kagel T, Lemburg S P. et al . Lipomatous hypertrophy of the interatrial septum: a prospective study of incidence, imaging findings, and clinical symptoms.  Chest. 2003;  124 2068-2073
    CrossrefPubMedGoogle Scholar
  • 22 Gowda R M, Khan I A, Nair C K. et al . Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases.  Am Heart J. 2003;  146 404-410
    CrossrefPubMedGoogle Scholar
  • 23 Grinda J M, Couetil J P, Chauvaud S. et al . Cardiac valve papillary fibroelastoma: surgical excision for revealed or potential embolization.  J Thorac Cardiovasc Surg. 1999;  117 106-110
    PubMedGoogle Scholar
  • 24 Shiraishi J, Tagawa M, Yamada T. et al . Papillary fibroelastoma of the aortic valve: evaluation with transesophageal echocardiography and magnetic resonance imaging.  Jpn Heart J. 2003;  44 799-803
    CrossrefPubMedGoogle Scholar
  • 25 Wintersperger B J, Becker C R, Gulbins H. et al . Tumors of the cardiac valves: imaging findings in magnetic resonance imaging, electron beam computed tomography, and echocardiography.  Eur Radiol. 2000;  10 443-449
    CrossrefPubMedGoogle Scholar
  • 26 Rienmuller R, Lloret J L, Tiling R. et al . MR imaging of pediatric cardiac tumors previously diagnosed by echocardiography.  J Comput Assist Tomogr. 1989;  13 621-626
    PubMedGoogle Scholar
  • 27 Cina S J, Smialek J E, Burke A P. et al . Primary cardiac tumors causing sudden death: a review of the literature.  Am J Forensic Med Pathol. 1996;  17 271-281
    CrossrefPubMedGoogle Scholar
  • 28 Brechtel K, Reddy G P, Higgins C B. Cardiac fibroma in an infant: magnetic resonance imaging characteristics.  J Cardiovasc Magn Reson. 1999;  1 159-161
    PubMedGoogle Scholar
  • 29 Kiaffas M G, Powell A J, Geva T. Magnetic resonance imaging evaluation of cardiac tumor characteristics in infants and children.  Am J Cardiol. 2002;  89 1229-1233
    CrossrefPubMedGoogle Scholar
  • 30 Orr L A, Pettigrew R I, Churchwell A L. et al . Gadolinium utilization in the MR evaluation of cardiac paraganglioma.  Clin Imaging. 1997;  21 404-406
    CrossrefPubMedGoogle Scholar
  • 31 Brodwater B, Erasmus J, McAdams H P. et al . Case report. Pericardial hemangioma.  J Comput Assist Tomogr. 1996;  20 954-956
    CrossrefPubMedGoogle Scholar
  • 32 Janigan D T, Husain A, Robinson N A. Cardiac angiosarcomas. A review and a case report.  Cancer. 1986;  57 852-859
    CrossrefPubMedGoogle Scholar
  • 33 Silver M A, Macher A M, Reichert C M. et al . Cardiac involvement by Kaposi’s sarcoma in acquired immune deficiency syndrome (AIDS).  Am J Cardiol. 1984;  53 983-985
    CrossrefPubMedGoogle Scholar
  • 34 Rettmar K, Stierle U, Sheikhzadeh A. et al . Primary angiosarcoma of the heart. Report of a case and review of the literature.  Jpn Heart J. 1993;  34 667-683
    PubMedGoogle Scholar
  • 35 Mukohara N, Tobe S, Azami T. Angiosarcoma causing cardiac rupture.  Jpn J Thorac Cardiovasc Surg. 2001;  49 516-518
    PubMedGoogle Scholar
  • 36 Corso R B, Kraychete N, Nardeli S. et al . Spontaneous rupture of a right atrial angiosarcoma and cardiac tamponade.  Arq Bras Cardiol. 2003;  81 611-613, 608 - 610
    PubMedGoogle Scholar
  • 37 Bruna J, Lockwood M. Primary heart angiosarcoma detected by computed tomography and magnetic resonance imaging.  Eur Radiol. 1998;  8 66-68
    CrossrefPubMedGoogle Scholar
  • 38 Villacampa V M, Villarreal M, Ros L H. et al . Cardiac rhabdomyosarcoma: diagnosis by MR imaging.  Eur Radiol. 1999;  9 634-637
    CrossrefPubMedGoogle Scholar
  • 39 Hoffmeier A, Deiters S, Schmidt C. et al . Radical resection of cardiac sarcoma.  Thorac Cardiovasc Surg. 2004;  52 77-81
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Watanabe A T, Teitelbaum G P, Henderson R W. et al . Magnetic resonance imaging of cardiac sarcomas.  J Thorac Imaging. 1989;  4 90-92
    PubMedGoogle Scholar
  • 41 Ceresoli G L, Ferreri A J, Bucci E. et al . Primary cardiac lymphoma in immunocompetent patients: diagnostic and therapeutic management.  Cancer. 1997;  80 1497-1506
    CrossrefPubMedGoogle Scholar
  • 42 Anghel G, Zoli V, Petti N. et al . Primary cardiac lymphoma: report of two cases occurring in immunocompetent subjects.  Leuk Lymphoma. 2004;  45 781-788
    CrossrefPubMedGoogle Scholar
  • 43 Nakakuki T, Masuoka H, Ishikura K. et al . A case of primary cardiac lymphoma located in the pericardial effusion.  Heart Vessels. 2004;  19 199-202
    PubMedGoogle Scholar
  • 44 Tada H, Asazuma K, Ohya E. et al . Images in cardiovascular medicine. Primary cardiac B-cell lymphoma.  Circulation. 1998;  97 220-221
    PubMedGoogle Scholar
  • 45 Dorsay T A, Ho V B, Rovira M J. et al . Primary cardiac lymphoma: CT and MR findings.  J Comput Assist Tomogr. 1993;  17 978-981
    PubMedGoogle Scholar
  • 46 Kubo S, Tadamura E, Yamamuro M. et al . Primary cardiac lymphoma demonstrated by delayed contrast-enhanced magnetic resonance imaging.  J Comput Assist Tomogr. 2004;  28 849-851
    PubMedGoogle Scholar
  • 47 Suman S, Schofield P, Large S. Primary pericardial mesothelioma presenting as pericardial constriction: a case report.  Heart. 2004;  90 e4
    CrossrefPubMedGoogle Scholar
  • 48 Kobayashi Y, Murakami R, Ogura J. et al . Primary pericardial mesothelioma: a case report.  Eur Radiol. 2001;  11 2258-2261
    CrossrefPubMedGoogle Scholar
  • 49 Mahnken A H, Tacke J. Myokardiale Herzmetastase bei fortgeschrittenem Nierenzellkarzinom.  Fortschr Röntgenstr. 2000;  172 488-490
    PubMedGoogle Scholar
  • 50 Hanfling S M. Metastatic cancer to the heart. Review of the literature and report of 127 cases.  Circulation. 1960;  22 474-483
    CrossrefPubMedGoogle Scholar
  • 51 Glancy D L, Roberts W C. The heart in malignant melanoma. A study of 70 autopsy cases.  Am J Cardiol. 1968;  21 555-571
    CrossrefPubMedGoogle Scholar
  • 52 Fujita N, Caputo G R, Higgins C B. Diagnosis and characterization of intracardiac masses by magnetic resonance imaging.  Am J Card Imaging. 1994;  8 69-80
    PubMedGoogle Scholar
  • 53 van Dantzig J M, Delemarre B J, Bot H. et al . Left ventricular thrombus in acute myocardial infarction.  Eur Heart J. 1996;  17 1640-1645
    PubMedGoogle Scholar
  • 54 Jungehulsing M, Sechtem U, Theissen P. et al . Left ventricular thrombi: evaluation with spin-echo and gradient-echo MR imaging.  Radiology. 1992;  182 225-229
    PubMedGoogle Scholar
  • 55 Bruder O, Waltering K U, Hunold P. et al . Detektion und Charakterisierung linksventrikulärer Thromben mittels MRT im Vergleich zur transthorakalen Echokardiographie.  Fortschr Röntgenstr. 2005;  177 344-349
    PubMedGoogle Scholar
  • 56 Simonetti O P, Kim R J, Fieno D S. et al . An improved MR imaging technique for the visualization of myocardial infarction.  Radiology. 2001;  218 215-223
    PubMedGoogle Scholar
  • 57 Barkhausen J, Hunold P, Eggebrecht H. et al . Detection and characterization of intracardiac thrombi on MR imaging.  AJR Am J Roentgenol. 2002;  179 1539-1544
    PubMedGoogle Scholar
  • 58 Paydarfar D, Krieger D, Dib N. et al . In vivo magnetic resonance imaging and surgical histopathology of intracardiac masses: distinct features of subacute thrombi.  Cardiology. 2001;  95 40-47
    CrossrefPubMedGoogle Scholar
  • 59 Meier R A, Hartnell G G. MRI of right atrial pseudomass: is it really a diagnostic problem?.  J Comput Assist Tomogr. 1994;  18 398-401
    PubMedGoogle Scholar

Dr. med. Gabriele A. Krombach

Klinik für Radiologische Diagnostik, Universitätsklinikum

Pauwelsstraße 30

52074 Aachen

Phone: ++ 49/2 41/8 08 83 32

Fax: ++ 49/2 41/8 08 24 99

Email: krombach@rad.rwth-aachen.de

      >