Myxoma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Ahmad Al Maradni, M.D. [3]Maria Fernanda Villarreal, M.D. [4]

Overview

On Magnetic Resonance Imaging (MRI) or Cardiac Magenetic Resonance(CMR), cardiac myxoma is characterized by a soft tissue mass within the cardiac chambers isointense to skeletal muscle. This imaging modality, plays an important role in the evaluation of cardiac masses and is of great value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.

MRI

MRI appearances are heterogeneous, reflecting the non-uniformity of these masses. They are typically spherical or ovoid masses which may be sessile or pedunculated.

• T1: tend to be low to intermediate signal, but areas of haemorrhage may be high
• T2: can be variable due to heterogeneity in tumour componants; e.g calcific components > low signal; myxomatous components > high signal
• GE (gradient echo): may show blooming of calcific components
• T1 C+ (Gd): shows enhancement (important discriminator from a thrombus)

Gallery

• 
  Axial T1-weighted MRI shows a soft tissue mass within the left atrium isointense to skeletal muscle (arrowheads). A friable myxoma was removed from the left atrium of a 53-year-old man with cerebrovascular accidents.

Cardiac MRI in myxoma

ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance (DO NOT EDIT)

“

CMR may be used for clinical evaluation of cardiac masses, extracardiac structures, and involvement and characterization of masses in the differentiation of tumors from thrombi.

”

Imaging Technique	Features	Description	Advantages	Limitations
Two- or three-dimensional echocardiography	Echocardiography is usually the initial modality used for identification and evaluation of cardiac myxomas.	Hyperechogenic lesions with a well-defined stalk Protrusion into the ventricles is a common finding	Real-time imaging Tumor mobility and distensibility	Limited views of the mediastinum and cannot be used to evaluate extracardiac manifestations of disease. TEE is an invasive imaging technique. TT is limited by the imaging window, which can vary with the patient and operator experience.
MRI	Evaluation of cardiac masses and is of greatest value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.	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.	MRI allows imaging in multiple planes Provides some functional information such as, flow direction and flow velocity in large vessels	Cannot show calcification High susceptibility to motion artifact. Dependent on regular electrocardiographic rhythms and cardiac gating.
CT	CT can be used to accurately image the heart and surrounding mediastinum	Intracardiac heterogeneously low attenuating mass The attenuation is usually lower than that of myocardium Calcification is common	CT provides better soft-tissue contrast	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.
Angiography	Coronary angiography may be helpful to detect vascular supply of the tumor by the coronary arteries	The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of tortuous vessels that correspond to tumor vasculature	Angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma Helpful for surgical evaluation	Invasive imaging technique
Chest x-ray	Chest x-ray has no particular findings associated with cardiac myxoma	Results can be normal	Low cost May be helpful, if calcifications present	Does not provide a diagnosis

References

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