Radiologic-Pathologic Correlation of Cardiac Tumors: Updated 2021 WHO Tumor Classification.

Cardiac tumors, although rare, carry high morbidity and mortality rates. They are commonly first identified either at echocardiography or incidentally at thoracoabdominal CT performed for noncardiac indications. Multimodality imaging often helps to determine the cause of these masses. Cardiac tumors comprise a distinct category in the World Health Organization (WHO) classification of tumors. The updated 2021 WHO classification of tumors of the heart incorporates new entities and reclassifies others. In the new classification system, papillary fibroelastoma is recognized as the most common primary cardiac neoplasm. Pseudotumors including thrombi and anatomic variants (eg, crista terminalis, accessory papillary muscles, or coumadin ridge) are the most common intracardiac masses identified at imaging. Cardiac metastases are substantially more common than primary cardiac tumors. Although echocardiography is usually the first examination, cardiac MRI is the modality of choice for the identification and characterization of cardiac masses. Cardiac CT serves as an alternative in patients who cannot tolerate MRI. PET performed with CT or MRI enables metabolic characterization of malignant cardiac masses. Imaging individualized to a particular tumor type and location is crucial for treatment planning. Tumor terminology changes as our understanding of tumor biology and behavior evolves. Familiarity with the updated classification system is important as a guide to radiologic investigation and medical or surgical management. ©RSNA, 2024 Supplemental material is available for this article.

Standardized Criteria for Identification of Cardiac Tamponade on Non-Electrocardiogram-gated Computed Tomography: Correlation With Echocardiographic Findings.

PURPOSE: To identify imaging parameters that can help in the diagnosis of cardiac tamponade on non-electrocardiogram (ECG)-gated computed tomography (CT) of the chest. MATERIALS AND METHODS: Retrospective analysis of 64 patients who had undergone CT and echocardiography for evaluation of cardiac tamponade. Of 64 patients, 34 were diagnosed with tamponade and underwent pericardiocentesis for further diagnosis and treatment. CT measurements obtained were: pericardial effusion (PeEff) pocket size in 6 locations (anterior, posterior, superior, inferior, right, and left lateral), pericardial thickening, diameters of the coronary sinus, upper superior vena cava, lower superior vena cava, and inferior vena cava. In addition, cardiac chamber sizes were measured. Subjective assessment of coronary sinus compression, pericardial enhancement, and pericardial thickening were also recorded. RESULTS: Measurement of the sum of the right lateral and left lateral PeEff thickness resulted in 91.2% sensitivity and 86.7% specificity for cardiac tamponade with a threshold of 30 mm (receiver-operating characteristic area under the curve=0.94 [0.84 to 0.98], P <0.0001). Using the combination of inferior PeEff >16 mm, sum of right lateral and left lateral PeEff>30 mm, and presence of pericardial thickening resulted in 56% sensitivity and 100% specificity and positive predictive value for the determination of cardiac tamponade. CONCLUSIONS: Our study suggests that CT measurements related to PeEff size and thickness aid in the diagnosis of cardiac tamponade.

Left atrial transverse diameter on computed tomography angiography can accurately diagnose left atrial enlargement in patients with atrial fibrillation.

PURPOSE: Left atrial (LA) enlargement is associated with increased risk for adverse cardiovascular events. We assessed the accuracy of LA transverse and antero-posterior (AP) diameters obtained from chest computed tomography (CT) angiography in patients with atrial fibrillation. MATERIALS AND METHODS: Nongated contrast-enhanced 64-slice multidetector CT angiography (slice thickness of 0.625 to 1.25 mm) was used to measure the volume and transverse and AP diameters of the LA in 222 subjects. The internal contours of the LA and LA appendage were outlined in 1 of every 5 axial images, and the LA area was multiplied by 5 times the slice thickness. Maximum transverse and AP diameters of the LA were measured, excluding the appendage. Receiver operating characteristic curves were fitted to assess the accuracy of the diameters. A Wald test was used to compare the area under the curves. RESULTS: The mean age of patients was 60.0±10.6 years, and 71% were male. Median LA volume was 55.9±24.4 mL/m. LA enlargement was present in 83% of the patients. Transverse and AP LA diameters were accurate estimators of the LA enlargement. The transverse diameter demonstrated higher accuracy than the AP diameter, with area under the curves of 0.89 (0.84 to 0.94) and 0.81 (0.73 to 0.89), respectively (P<0.05). A transverse LA diameter of 7.3 cm had a sensitivity and specificity of 85% for detection of LA enlargement. At the same sensitivity level, an AP diameter of 4.3 cm had a specificity of 60.5%. CONCLUSIONS: Transverse LA diameter can accurately detect LA enlargement in patients with atrial fibrillation. This parameter can be used for detection of patients with possible LA enlargement on chest CT angiography.

Ventricular mechanics: techniques and applications.

Magnetic resonance assessment of regional myocardial function is a novel potentially important tool for early identification of cardiac pathology. Many cardiac magnetic resonance techniques have been developed for detection and quantification of regional strain abnormalities including steady-state free-precession CINE, tagging, displacement encoding with stimulated echoes, strain encoding imaging, and feature tracking. Potential clinical applications of magnetic resonance strain imaging include early detection of systolic dysfunction in heart failure patients with both ischemic and nonischemic etiologies.