Thread by @purviparwani

Check out our review on the utility of #whyCMR in the differentiation of #cardiac #mass

link.springer.com/article/10.100…

Mini-Tweetorial Follows:
#CardioOnc #cvImaging #ACCimaging
@onco_cardiology @JStojanovskaMD @MichaelCoMD
@DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 Incidence of Cardiac Metastases: 1.23%
Primary Cardiac Tumors 0.056%

Can be benign, malignant or pseudotumor
Primary Cardiac tumor- mostly benign

#Cardiac Mass eval: detailed clinical presentation, History, Physical Exam, #echofirst to see the tumor characteristics

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 #whyCMR helps with high accuracy and able to provide the diagnosis in cases of cardiac #mass

#whyCMR eval:
Cine imaging
T1 and T2 weight imaging with and without FS
First Pass Perfusion
EGE, LGE & post-Gad T1W imaging

@fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 @fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan I will summarize the #whyCMR characteristics of different tumors below.

Myxoma:
Most frequent cardiac Tumor
commonly seen in the LA attached to the IAS
#whyCMR
T1W: Iso or Hypointense
T2W: High intensity
LGE: mostly Heterogenous enhancement

@Hragy @mirvatalasnag

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 @fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan @Hragy @mirvatalasnag PFE:
2nd most common cardiac Tumor
75% of valvular tumor
#whyCMR
T1W: Isointense
T2W: Iso or Hypointense
LGE: near Homogenous enhancement

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 @fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan @Hragy @mirvatalasnag Lipoma
8.4% of all benign cardiac tumors
usually found in the LV, RA or IAS
#whyCMR
T1W and T2W: HYPER intense with suppression on Fat Sat prepulse
LGE: No enhancement

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 @fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan @Hragy @mirvatalasnag Rhabdomyoma:
6% of all benign tumors.
most often seen in children and are rare in adults
multiple, small, lobulated, hyperechogenic and can be found intramyocardial
T1W: Iso-intense
T2W: Iso-intense to mildly hyperintense
LGE: No enhancement

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 @fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan @Hragy @mirvatalasnag Fibroma
more common in the pediatric population.

generally seen in isolation and mostly localized to left ventricle, can be seen in atria especially with polyposis syndrome

T1W: Iso-intense
T2W: Hypo-Intense
LGE: Hyper-Intense (Light-Bulb Enhancement)

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 @fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan @Hragy @mirvatalasnag Hemangiomas:

5%-10% of all primary benign cardiac tumors
T1W: Iso-intense
T2W: Iso or Hyperintense
LGE: Heterogenous Uptake

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 @fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan @Hragy @mirvatalasnag Angio Sarcoma:
Most common primary Malignant Tumor
Main role of #whyCMR is the extension into cardiac & extra-cardiac structures
Can have heterogenous appearance on #whyCMR

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 @fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan @Hragy @mirvatalasnag Lymphoma:
1.3% of all primary cardiac malignancies
T1W: Iso-intense to hypointense
T2W: Iso or mildly Hyperintense
LGE: Variable uptake

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 @fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan @Hragy @mirvatalasnag Metastases:

substantially more common than primary malignancy
T1-Wimaging of most secondary cardiac malignancies is low intensity & high signal intensity on T2-W imaging
A notable exception to this is metastatic melanoma, which appears hyperintense on T1-W imaging

@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 @JoaoLCavalcante @almasthela @iamritu @DrMarthaGulati @hvanspall @venkmurthy @aayshacader @IAmDrIbrahim @poojaotherwise @mswami001 @fabrizioricci @MasriAhmadMD @cshenoy3 @afshinfarzan @Hragy @mirvatalasnag In general utility of #whyCMR is manyfold in eval of #cardiac mass
The differential diagnosis can be challenging given the rarity of the tumors.

Thank you @onco_cardiology for this opportunity.
It was a fun project with one of the biggest #HeforShe in my professional life.