Incremental Utility of First-Pass Perfusion CMR for Prognostic Risk Stratification of Cancer-Associated Cardiac...

Area of Science:

• Cardiovascular Imaging
• Oncology
• Radiology

Background:

• Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) differentiates cardiac metastasis (C_MET) from cardiac thrombus (C_THR) based on vascularity.
• The diagnostic and prognostic utility of perfusion CMR for cardiac masses (C_MASS) remains largely unknown.

Purpose of the Study:

• To evaluate the diagnostic and prognostic value of perfusion CMR for cardiac masses (C_MASS).
• To determine if perfusion CMR offers utility beyond differentiating C_MET from C_THR.

Main Methods:

• Adult cancer patients with C_MASS on CMR were analyzed.
• Cardiac metastasis (C_MET) and cardiac thrombus (C_THR) were identified using LGE-CMR.
• First-pass perfusion CMR assessed C_MASS vascularity via contrast enhancement ratio (CER) and contrast uptake rate (CUR); all-cause mortality was tracked.

Main Results:

• Perfusion CMR parameters (CER, CUR) were significantly higher in C_MET compared to C_THR (P < 0.001).
• CUR demonstrated superior performance (AUC: 0.89-0.93) over CER (AUC: 0.66-0.72) for differentiating C_MET and C_THR.
• Patients with C_MET showed higher mortality (HR: 1.42-1.52) compared to controls, with increased risk correlating to lower lesion vascularity (hypoperfusion) on perfusion CMR.

Conclusions:

• Perfusion CMR provides prognostic information that complements LGE-CMR findings for cardiac masses.
• In cancer patients with C_MET, increased mortality is associated with greater lesion hypoperfusion, as evidenced by perfusion CMR.