Diagnostic Accuracy of an Integrated Multimodality Imaging Approach in Patients With Cardiac Masses

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Multimodality imaging is crucial for evaluating cardiac masses (CMs).
• Comparative performance of integrated imaging strategies like CMR, CCT, and 18F-FDG PET for CMs is not fully understood.

Purpose of the Study:

• To compare the diagnostic accuracy of echocardiography, CMR, CCT, and 18F-FDG PET for identifying malignant CMs.
• To evaluate the diagnostic performance of these imaging modalities individually and in combination, using histology as the reference standard.

Main Methods:

• Prospective study involving 142 patients with suspected CMs undergoing echocardiography, CCT, CMR, and 18F-FDG PET.
• Diagnostic performance assessed using receiver-operating characteristic curves and DeLong test for AUC comparison.
• CART analysis evaluated the incremental value of PET after CMR or CCT.

Main Results:

• Malignant CMs were present in 54% of patients. CMR showed the highest standalone accuracy (AUC: 0.94), outperforming CCT and 18F-FDG PET (AUC: 0.85).
• The combination of CMR and 18F-FDG PET achieved high diagnostic accuracy (AUC: 0.97), with 95.1% PPV and 100% NPV.
• CCT combined with 18F-FDG PET yielded an AUC of 0.92. PET addition improved classification in selected cases.

Conclusions:

• CMR is the most accurate standalone imaging modality for detecting cardiac mass malignancy.
• Integrating 18F-FDG PET with CMR enhances diagnostic performance in ambiguous cases.
• CCT combined with 18F-FDG PET offers a reliable alternative for diagnosing malignant cardiac masses.