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Mitral annular calcification: Can CMR be useful in identifying caseous necrosis?
Matteo Gravina1, Grazia Casavecchia2, Vincenzo Manuppelli2
1Department of Radiology, University of Foggia, Foggia, Italy.
Interventional Medicine & Applied Science
|March 10, 2020
Summary
Caseous mitral annulus calcification (CMAC) can mimic cardiac tumors. Advanced imaging like cardiac MRI and MDCT are crucial for accurate diagnosis of this rare condition.
Area of Science:
- Cardiology
- Radiology
- Pathology
Background:
- Mitral annular calcification (MAC) is a chronic degeneration of the mitral annulus.
- Caseous mitral annulus calcification (CMAC) is an extensive form of MAC that can mimic intracardiac masses.
- Accurate differentiation of CMAC from true cardiac tumors is essential for appropriate patient management.
Purpose of the Study:
- To present a case of CMAC diagnosed using advanced imaging modalities.
- To highlight the characteristic imaging findings of CMAC on cardiac magnetic resonance (CMR) and multidetector computed tomography (MDCT).
- To emphasize the role of CMR and MDCT in diagnosing CMAC.
Main Methods:
- Transthoracic and transesophageal echocardiography were performed.
- Cardiac magnetic resonance (CMR) imaging with delayed enhancement sequences was utilized.
- Multidetector computed tomography (MDCT) was conducted for further characterization.
Main Results:
- Echocardiography revealed a non-homogeneous, mobile mass on the mitral leaflet.
- CMR showed a non-enhanced central core with a hyperenhanced rim.
- MDCT demonstrated a hyperdense mass with a hypodense center and calcified rim, highly suggestive of CMAC.
Conclusions:
- CMAC can present as an intracardiac mass, posing a diagnostic challenge.
- CMR and MDCT provide complementary information for diagnosing CMAC.
- Advanced imaging is vital for differentiating CMAC from other cardiac masses.
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