Click on any image below to see an enlargement of that image.

Case 1: Pericardial Cyst
Case 2: Metastatic Merkel Cell Tumor
Axial image demonstrating enhancing lesion	Coronal image obtained during dynamic contrast administration
Case 3: Multiple Myeloma
Axial image demonstrating involvement of the right atrium with compression of the superior vena cava	Follow-up study (coronal image) obtained one year later after therapy demonstrating persistence of the lesion
Case 4: Myxosarcoma
Coronal image showing extensive cardiac and extra cardiac involvement	Gadolinium enhanced angiogram demonstrating involvement of right ventricle and encasement of pulmonary artery
Three chambers cine showing relationship of tumor to left ventricle

Above images are all original MR scans performed at Parkside MR Center.

Discussion

Tumors affecting the heart and pericardium are uncommon. Among these, metastases occur 10 to 40 times more frequently than primary malignancies. Metastatic involvement of the heart, more often of the pericardium than of the myocardium, may occur in any widely disseminated malignancy.¹ Lymphoma, breast carcinoma, and lung carcinoma are the most common types of malignancy to secondarily involve the heart and pericardium.

Approximately 80% of all primary cardiac tumors are benign. The majority of these are myxomas arising within the left atrium. The most common primary malignant tumors involving the heart are sarcoma, primary cardiac lymphoma, and pericardial mesothelioma.²

Echocardiography has been the mainstay in the evaluation of cardiac tumors, the majority of which are asymptomatic at presentation. Echocardiography, however, may be technically limited due to the absence of an optimal acoustic window and/or restricted field of view. MRI, with its multiplanar capability and inherent advantages in soft tissue characterization, can add substantial information when a mass is suspected during cardiac echo. Lesion evaluation can also be substantially improved with the use of ECG gating techniques and intravenous contrast. MRI also helps in differentiating tumor from thrombus.

MRI evaluation of cardiac tumors is particularly helpful in evaluating the extra cardiac extent of disease, especially when there is involvement of the mediastinum and great vessels. Cine MR imaging can be used to assess the functional significance of cardiac and vascular involvement of the tumor. Serial MR exams are also useful in assessing tumor response to surgery, radiation therapy, and chemotherapy.³

References:

1. Robbins, S.L., Cotran, R.S. and Kumar, V. Pathologic Basis of Disease, 3rd ed. Philadelphia: W.B. Sanders Co., 1984, 606.

2. Grebene, M.L. et al. Primary cardiac and pericardial neoplasms: Radiologicpathologic correlation. Radiographgics 2000: 20: 1073-1103.

3. Mader, M.T., Poulton, T.B., White, R.D. Malignant tumor the heart and great vessels: MR imaging appearance. Radiographics 1997: 17: 145-153.

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