Cardiac Magnetic Resonance to Predict Cardiac Mass Malignancy: The CMR Mass Score

Area of Science:

• Cardiology
• Medical Imaging
• Oncology

Background:

• Accurate diagnosis of cardiac masses is crucial for treatment.
• Distinguishing malignant from benign cardiac masses noninvasively is challenging.
• Multimodality imaging is currently recommended for cardiac mass diagnosis.

Purpose of the Study:

• To develop a cardiac magnetic resonance (CMR)-derived model to predict cardiac mass malignancy.
• To compare the accuracy of the CMR model against the echocardiographic mass score.
• To evaluate the prognostic ability of the CMR model.

Main Methods:

• 167 patients with suspected cardiac masses underwent echocardiogram and CMR.
• Logistic regression identified independent CMR predictors of malignancy.
• A CMR mass score was developed and validated against histology.
• Prognostic ability was assessed using survival analysis.

Main Results:

• CMR features like non-left localization, sessile/polylobate shape, infiltration, and pericardial effusion predicted malignancy.
• First-pass perfusion and heterogeneous enhancement on CMR were also malignancy predictors.
• The CMR mass score (cutoff ≥5) showed excellent accuracy (AUC 0.976), superior to echocardiography (AUC 0.932).
• A higher CMR mass score predicted increased all-cause mortality (HR 5.70).

Conclusions:

• A CMR-derived model integrating morphology and tissue characterization accurately predicts cardiac mass malignancy.
• This CMR model demonstrates superior diagnostic performance compared to echocardiography.
• The CMR mass score has significant prognostic implications for patient outcomes.