Cardiovascular magnetic resonance of cardiac tumors and masses

Table 1 Cardiovascular magnetic resonance characteristic (location, signal intensity and contrast contrast-enhanced relative to that of adjacent normal myocardium) of benign and malignant cardiac masses

Lesion		Location	T1-WI	T2-WI	Cine-SSFP	Perfusion	EGE	LGE
Non-neoplastic
	Thrombus Acute/subacute	Mural or intraluminal	Iso-Hyper	Iso-Hyper	Iso-hypo	No enhancement	No enhancement	Hypointense border and brighter central zone
	Thrombus Chronic	Mural or intraluminal	Hypo	Hypo	Iso-hypo	Rare	No enhancement	Rarely heterogeneous
	Pericardial cyst	Right cardiophrenic angle	Hypo	Hyper	Hyper	No enhancement	No enhancement	No enhancement
	Mitral annular calcification	Annular fibrous ring of the left atrio-ventricular valve	Hypo	Hypo	Iso-hypo	No enhancement	Peripheral rim of enhancement	Peripheral rim of enhancement
	Liquefaction necrosis	Annular fibrous ring of the left atrio-ventricular valve	Mildly Hyper	Mildly Hyper	Iso-hypo	No enhancement	Peripheral rim of enhancement	Peripheral rim of enhancement +/- core enhancement
Neoplastic - Benign
	Myxoma	Left atrium, arising from the interatrial septum	Iso (heterogeneous)	Hyper (heterogeneous)	Hypo	Heterogeneous	Heterogeneous	Heterogeneous
	Papillary fibroelastoma	Atrial side of the mitral valve and the aortic surface of the aortic valve leaflet	Iso	Iso	Hypo	Usually not assessable	Mild and homogeneous or no enhancement	Homogeneous or no enhancement
	Lipoma	Atrial septum and epicardium, but it may occur anywhere in the heart	Hyper	Hyper (Hypo on STIR images)	Hyper (with black boundary artifact or India ink artifact)	No enhancement	No enhancement	No enhancement
	Hemangioma	Every cardiac chamber and also from pericardial space	Iso	Hyper	Hyper	Heterogeneous, intense and prolonged	Homogeneous or heterogeneous	Homogeneous or heterogeneous
	Fibroma	Intramural growth in the ventricles (interventricular septum or the ventricular free wall)	Iso	Hypo	Iso-hypo	Mild and homogeneous	Mild and homogeneous	No enhancement or minimal uptake
	Rhabdomyoma	Intramyocardial or intracavitary, with intraventricular growth that may cause outflow obstruction	Iso	Mildly Hyper	Iso-hypo	No enhancement or minimal uptake	No enhancement or minimal uptake	No enhancement or minimal uptake
	Cardiac teratomas	Intrapericardial (usually compressing superior vena cava and/or right atrium)	Iso or Hypo	Hyper	Iso or Slightly hyper	No enhancement	Mild and heterogeneous	Heterogeneous
	Paraganglioma	On the roof of left atrium	Iso-Hypo with “salt and pepper” appearance	Hyper with “salt and pepper” appearance	Hyper	Strong enhancement	Heterogeneous Peripheral	Heterogeneous Peripheral
Neoplastic - malignant: Primary cardiac tumor
	Angiosarcoma	Right atrium close to atrio-ventricular sulcus	Iso-Hyper (heterogeneous)	Hyper (heterogeneous)	Iso (heterogeneous)	Strong enhancement	Marked and Heterogeneous	Marked and Heterogeneous
	Leiomyosarcoma	Typically involve the left atrium	Iso	Iso-Hyper	Iso	Heterogeneous, intense	Marked and Heterogeneous	Marked and Heterogeneous
	Rhabdomyosarcoma	Multiple masses and there is not any predilection in terms of cardiac structures involved	Iso	Iso-Hyper (hyper on STIR images)	Iso	Heterogeneous, intense	Marked and Heterogeneous	Marked and Heterogeneous
	Lymphoma	Right chambers, often right ventricle and are associated with pericardial effusion	Hypo-Iso	Mildly Hyper (more evident on STIR images)	Iso	Mild	Heterogeneous	No or progressive mild heterogeneous enhancement
	Mesothelioma	Pericardium	Iso	Hyper (heterogeneous)	Iso	Progressive enhancement	Intense enhancement	Intense enhancement
Malignant - Malignant: metastatic disease		Mainly involve myocardium and pericardium	Low (except for Melanoma which is Hyper)	Hyper	Iso	Heterogeneous	Heterogeneous	Heterogeneous

T1-WI: T1-weighted images; T2-WI: T2-weighted images; STIR: Short tau inversion recovery; Cine-SSFP: Cine-steady state free precession; EGE: Early gadolinium enhancement; LGE: Late gadolinium enhancement; Hypo: Hypointense; Iso: Isointense; Hyper: Hyperintense.

Table 2 Malignant tumor characteristic

Size	More than 5 cm
Number	More than one
Location	Right heart involvement or more than one cardiac chamber
Implantation	Broad base of implantation
Infiltration	Direct infiltration of structures such as myocardium, valves, epicardial fat and pericardial leaflets
Effusion	Pericardial or pleural hemorrhagic effusion
Signal intensity	Heterogeneous signal intensity in T1-weighted and T2-weighted images
Perfusion	Heterogeneous enhancement
EGE and LGE	Heterogeneous enhancement

EGE: Early gadolinium enhancement; LGE: Late gadolinium enhancement.