The usefulness of contrast echocardiography in the evaluation of cardiac masses: a multicenter study
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Updated: Jul 5, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Qingtao Wang1, Bing Wang1, Xiaofeng Zhang2
1Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China.
Insights
Contrast echocardiography (CE) accurately differentiates cardiac tumors from thrombi. This study evaluated CE
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Technology
Background:
- Cardiac masses include tumors, thrombi, and vegetations, requiring accurate differentiation for effective management.
- Distinguishing cardiac tumors from thrombi is crucial due to differing treatment strategies.
- Contrast echocardiography (CE) shows promise for cardiac mass diagnosis, but evidence is limited.
Purpose of the Study:
- To evaluate the diagnostic accuracy of contrast echocardiography (CE) in differentiating cardiac masses.
- To address the insufficient evidence for differential diagnosis of cardiac masses using CE.
- To assess the effectiveness of CE in distinguishing between cardiac tumors and thrombi.
Main Methods:
- A prospective multicenter study included 145 patients with suspected cardiac masses.
- All patients underwent contrast echocardiography (CE) examinations.
- Diagnosis utilized qualitative factors (echogenicity, perfusion) and quantitative factors (mass area, A1/A2 ratio).
Main Results:
- The study included 145 patients with final diagnoses: 43 thrombi, 66 benign tumors, 30 malignant tumors.
- An A1/A2 ratio cutoff of 0.499 distinguished tumors from thrombi with high accuracy (AUC 0.977).
- Another A1/A2 ratio cutoff of 1.583 also showed high accuracy in differentiating tumors from thrombi (AUC 0.950).
Conclusions:
- Contrast echocardiography (CE) demonstrates significant potential in accurately differentiating cardiac masses.
- Combined qualitative and quantitative analyses enhance CE's diagnostic capabilities for cardiac masses.
- CE is a valuable tool for distinguishing cardiac tumors from thrombi.
Background:
Cardiac masses can encompass a variety of conditions, such as tumors, thrombi, vegetations, calcific lesions, and other rare diseases. Treatment and management of these types of cardiac masses differ considerably. Thus, accurately distinguishing among thrombi, benign tumors, and malignant tumors in the heart is of great importance. Contrast echocardiography (CE) has emerged as a promising technology. Although published guidelines suggest that CE can enhance image quality and assist in differentiating between benign and malignant lesions, most studies on CE diagnosis of cardiac masses are limited to case reports or retrospective/small-sample-sized prospective cohorts. This study aims to evaluate the diagnostic accuracy of CE in patients with suspected cardiac masses and address the insufficient evidence for differential diagnosis using CE.
Methods:
Between April 2018 and July 2022, a prospective multicenter study was conducted, which included 145 consecutive patients suspected to have cardiac masses based on transthoracic echocardiography. All patients underwent CE examinations. The echocardiographic diagnosis relied on qualitative factors such as echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility as well as quantitative factors such as the area of the masses and the peak intensity ratio of the masses to adjacent myocardium (A1/A2).
Results:
The final confirmed diagnoses were as follows: 2 patients had no cardiac mass, 4 patients had pseudomass, 43 patients had thrombus, 66 patients had benign tumors, and 30 patients had malignant tumors. The receiver operating characteristic (ROC) analysis indicated that an optimal A1/A2 cutoff value of 0.499 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.977, 97.9%, 90.7%, 95.9%, and 95.1%, respectively. The optimal A1/A2 cutoff value of 1.583 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.950, 93.3%, 93.9%, 87.5%, and 96.9%, respectively.
Conclusions:
Combined with qualitative and quantitative analyses, CE has the potential to accurately differentiate among different types of cardiac masses.
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