Imaging Technique
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Features
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Description
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Advantages
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Limitations
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Two- or three-dimensional echocardiography
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Echocardiography is usually the initial modality used for identification and evaluation of cardiac myxomas.
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- Hyperechogenic lesions with a well-defined stalk
- Protrusion into the ventricles is a common finding
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- Real-time imaging
- Tumor mobility and distensibility
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- Limited views of the mediastinum and cannot be used to evaluate extracardiac manifestations of disease.[1]
- TEE is an invasive imaging technique.
- TT is limited by the imaging window, which can vary with the patient and operator experience.
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MRI
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Evaluation of cardiac masses and is of greatest value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.
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- Cardiac myxomas appear spherical or ovoid with lobular contours, irregular in shape.
- T1 : Low to intermediate signal, but areas of hemorrhage may be high.
- T1 C+ (Gd): shows enhancement (important discriminator from a thrombus) demonstrates uniform heterogeneous enhancement.
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- MRI allows imaging in multiple planes
- Provides some functional information such as, flow direction and flow velocity in large vessels
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- Cannot show calcification
- High susceptibility to motion artifact.
- Dependent on regular electrocardiographic rhythms and cardiac gating.
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CT
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CT can be used to accurately image the heart and surrounding mediastinum
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- Intracardiac heterogeneously low attenuating mass
- The attenuation is usually lower than that of myocardium
- Calcification is common
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- CT provides better soft-tissue contrast
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- There is no real-time true imaging with CT and imaging planes are limited to those allowed by angulation of the gantry.
- There is no evaluation of small moving structures, such as the cardiac valves.
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Angiography
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Coronary angiography may be helpful to detect vascular supply of the tumor by the coronary arteries
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- The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of tortuous vessels that correspond to tumor vasculature
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- Angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma
- Helpful for surgical evaluation
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- Invasive imaging technique
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Chest x-ray
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Chest x-ray has no particular findings associated with cardiac myxoma
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- Low cost
- May be helpful, if calcifications present
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- Does not provide a diagnosis
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