Utilidad de la imagen en multi-modalidad para el diagnóstico diferencial de las masas cardÃacas
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Date
2016
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es
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Sociedad Chilena de CardiologÃa y CirugÃa Cardiovascular
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Abstract
Introducción: El presente trabajo es un estudio descriptivo de una serie de casos con masas cardÃacas cuyo estudio involucró múltiples modalidades de imagen no invasiva, incluyendo Ecocardiograma (ECO), TomografÃa Axial Computada CardÃaca (TAC), PET/CT (TomografÃa de Emisión de Positrones) y Resonancia nuclear magnética (RNM) CardÃaca. Objetivo: Establecer la capacidad diagnóstica de la multa-modalidad de imagen en el estudio etiológico y localización de una masa cardÃaca pesquisada inicialmente por ECO transtorácico. Método: Se realizó un análisis descriptivo de 37 casos estudiados con diversas modalidades de imagen no invasiva en Vanderbilt University Medical Center, Nashville, Tennessee, entre Julio 2014 y Julio 2015, La naturaleza de las masas fue determinada por biopsia, cirugÃa o seguimiento clÃnico. Resultados: Del total de masas, 14 (39%) fueron tumores confirmados por biopsia; 11 (30%) correspondieron a trombos; 1 caso (2.8%) fue una masa valvular infecciosa; 1 caso (2.8%) correspondió a calcificación caseosa del anillo Mitral; 1 caso (2.8%) fue variante normal y solo 1 caso (2.8%) fue indeterminado; 6 (17%) casos fueron masas de localización extracardÃaca. La modalidad ECO + RNM CardÃaca fue suficiente para caracterizar localización y tipo histológico en 28 casos (76%); la modalidad ECO + TAC CardÃaca + RNM CardÃaca fue necesaria en 7 casos (19%); La modalidad ECO + TAC CardÃaca + RNM CardÃaca + PET/CT fue necesaria en 1 caso (2.5%) para la actividad mitótica celular; la modalidad ECO + RNM CardÃaca + PET/CT fue necesaria en 1 caso (2.5%) para localización, tipo histológico, calcio y actividad infecciosa. La modalidad ECO + TAC CardÃaca no permitió identificar localización, tipo histológico con calcificación y /o tejido adiposo. Conclusión: La multi-modalidad de imagen permitió identificar la etiologÃa y localización de la masa cardÃaca en el 97% de los casos. La combinación ECO + RNM CardÃaca fue la modalidad más usada. La TAC CardÃaca es particularmente útil para caracterizar calcificaciones y/o tejido adiposo y el PET/CT para caracterizar actividad metabólica (infección activa y actividad mitótica celular).
Background: We analyzed a series of patients with cardiac masses who were studied using multiple imaging modalities, including echocardiography (ECHO), CT Scan, Magnetic Resonance imaging (RNM) and PET/CT Aim: to determine the usefulness of multi-modality imaging in determining the etiology and location of cardiac masses initially detected by ECHO Methods: 37 patients selected by the presence of a cardiac mass detected by ECHO were submitted to different modalities of cardiac imaging in order to determine the nature, location and etiology of the mass Results: 14 (39%) masses were tumors confirmed by biopsy; 11 (30%) fulfilled criteria to diagnose a thrombus; 1 patient (2.8%) had an infectious cardiac mass, another calcification of the mitral an-nulus, another turned out to be a normal variant and only in one patient (2.8%) a diagnosis was not possible. Six patients had extra cardiac masses. ECHO plus RNM were sufficient to characterize location and histologic type in 28 patients (76%). Seven cases (19%) required ECHO plus CT scan. ECHO plus CT scan plus RNM plus PET/CT was required in 1 patient to establish mitotic activity. ECHO plus RNM plus PT/CT was necessary to determine location, histologic type, presence of calcium and infectious activity Conclusion: Multimodality imaging allowed to determine etiology and location of cardiac masses in 97 % of cases. ECHO plus NMR was the combination most frequently used. CT scan was particularly useful to identify calcification and fat deposits and PET/CT to identify increased metabolic activity, either infection or mitotic activity.
Background: We analyzed a series of patients with cardiac masses who were studied using multiple imaging modalities, including echocardiography (ECHO), CT Scan, Magnetic Resonance imaging (RNM) and PET/CT Aim: to determine the usefulness of multi-modality imaging in determining the etiology and location of cardiac masses initially detected by ECHO Methods: 37 patients selected by the presence of a cardiac mass detected by ECHO were submitted to different modalities of cardiac imaging in order to determine the nature, location and etiology of the mass Results: 14 (39%) masses were tumors confirmed by biopsy; 11 (30%) fulfilled criteria to diagnose a thrombus; 1 patient (2.8%) had an infectious cardiac mass, another calcification of the mitral an-nulus, another turned out to be a normal variant and only in one patient (2.8%) a diagnosis was not possible. Six patients had extra cardiac masses. ECHO plus RNM were sufficient to characterize location and histologic type in 28 patients (76%). Seven cases (19%) required ECHO plus CT scan. ECHO plus CT scan plus RNM plus PET/CT was required in 1 patient to establish mitotic activity. ECHO plus RNM plus PT/CT was necessary to determine location, histologic type, presence of calcium and infectious activity Conclusion: Multimodality imaging allowed to determine etiology and location of cardiac masses in 97 % of cases. ECHO plus NMR was the combination most frequently used. CT scan was particularly useful to identify calcification and fat deposits and PET/CT to identify increased metabolic activity, either infection or mitotic activity.
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Indexación: Web of Science; Scielo
Keywords
Imagen CardÃaca No Invasiva, TAC CardÃaco, Resonancia Magnética CardÃaca, Ecografia CardÃaca, Multimodalidad
Citation
Rev Chil Cardiol vol.35 no.1 Santiago 2016