"Cardiac Masses" - Case-Based Webinar (CME)-Webinar

Video Transcription

Video Summary

The webinar, part of SCMR’s case-based educational series, focused on the cardiac MRI evaluation of cardiac masses. Dr. Rao introduced the speakers and outlined how attendees should use the Zoom Q&A and chat functions, noting the CME credit available. Dr. Grizzard opened by reviewing the CMR approach to cardiac masses: determine location, tissue characteristics, margins, vascularity, and enhancement. He emphasized distinguishing pseudomasses and normal variants from true lesions, and discussed benign entities such as thrombus, myxoma, papillary fibroelastoma, lipoma/lipomatous hypertrophy, rhabdomyoma, fibroma, paraganglioma, and hemangioma. Key imaging clues included bright T2 signal in myxoma and vascular enhancement in hypervascular tumors.<br /><br />Dr. Weinsaft then focused on thrombus versus neoplasm. He stressed that the critical question is whether a mass is vascular or avascular, which long inversion time late gadolinium enhancement (LGE) CMR can help answer. Thrombus appears black on long TI images, while neoplasms enhance. He reviewed evidence showing LGE-CMR outperforms echo and PET in detecting thrombus and characterizing cardiac metastases, and highlighted prognostic value from enhancement burden and lesion extent.<br /><br />Dr. Lopez-Mattei reinforced practical use of CMR as a “toolbox,” walking through additional cases of thrombus, angiosarcoma, papillary fibroelastoma, and metastatic cardiac sarcoma, and emphasizing multimodality integration with echo, CT, PET, biopsy, and surgery when needed.<br /><br />In the discussion, the speakers addressed gadolinium use in CKD, recommended routinely including long TI imaging in ischemic heart disease, and debated PSIR versus long TI methods. The session concluded with a reminder that all sessions are available on the SCMR website.

Keywords

cardiac MRI

cardiac masses

CMR

thrombus

neoplasm

late gadolinium enhancement

myxoma

papillary fibroelastoma

angiosarcoma

multimodality imaging