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Updated: May 25, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Using Computed Tomography Coronary Angiography to Differentiate Atypical Cardiac Myxoma From Thrombus
Nannan Zhang1,2, Chuanqiang Lan1, Zeliu Du1
1Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Imaging Diagnosis and Interventional Minimally Invasive Institute, Department of Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhengjiang, China.
Insights
CT coronary angiography effectively differentiates atypical cardiac myxoma from cardiac thrombus by identifying neovascularization in myxomas. This imaging technique aids in diagnosis, though further cardiac magnetic resonance imaging may be needed for other cardiac tumors.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Cardiac Pathology
Background:
- Atypical cardiac myxoma mimics cardiac thrombus on conventional imaging.
- Distinguishing these conditions is challenging with standard echocardiography or CT.
- Accurate differentiation is crucial for appropriate patient management.
Purpose of the Study:
- To evaluate the utility of CT coronary angiography (CTCA) imaging features in differentiating atypical cardiac myxoma from cardiac thrombus.
- To identify specific CTCA characteristics that distinguish between these two cardiac masses.
Main Methods:
- Retrospective analysis of 18 patients with atypical cardiac myxoma and 23 with cardiac thrombus.
- All patients underwent third-generation dual-source CT coronary angiography.
- Comparison of clinical and CTCA features, including neovascularization assessment using advanced visualization techniques.
Main Results:
- Significant differences observed in origin, surface, and enhancement patterns between myxoma and thrombus.
- Neovascularization (supplied vessels) was detected in 83.33% of atypical cardiac myxoma cases.
- No neovascularization was identified in any cardiac thrombus cases (0%).
Conclusions:
- CT coronary angiography is a valuable noninvasive tool for distinguishing atypical cardiac myxoma from cardiac thrombus.
- Detection of supplying vessels via CTCA is a key differentiating feature.
- Cardiac magnetic resonance imaging may be necessary for definitive diagnosis of various cardiac tumors.
Objective:
Atypical cardiac myxoma usually presents as an isolated mass attached to the atrial septum on imaging, with no movement and a wider attachment base. It is difficult to distinguish it from cardiac thrombus through conventional echocardiography or computed tomography (CT). The purpose of this study is to evaluate the value of CT coronary angiography imaging features in distinguishing atypical cardiac myxoma from cardiac thrombus.
Materials And Methods:
This retrospective study included patients with atypical myxoma of the heart confirmed by histopathology (n = 18) and with thrombus disappearance after anticoagulation treatment (n = 23). All patients underwent a third-generation dual-source CT coronary angiography. We compared the clinical features and CT coronary angiography image characteristics of the 2 groups and used maximum-intensity projection and multiplanar reconstruction to show neovascularization of atypical cardiac myxoma.
Results:
There are significant differences in the origin, surface, and enhancement patterns between atypical cardiac myxoma and thrombus ( P < 0.05, respectively). Specifically, supplied vessels were observed in the atypical cardiac myxoma group, while no neovascularization was detected in the thrombus group (83.33% vs. 0%, P < 0.001).
Conclusions:
Noninvasive CT coronary angiography can help distinguish atypical cardiac myxoma and cardiac thrombus through imaging features, especially by detecting the supplying vessels. However, supplementary examinations such as cardiac magnetic resonance imaging are still needed to identify different cardiac tumors.
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