Late gadolinium enhancement cardiac magnetic resonance tissue characterization for cancer-associated cardiac masses: Metabolic and prognostic manifestations in relation to whole-body positron emission tomography Journal Article


Authors: Chan, A. T.; Fox, J.; Perez Johnston, R.; Kim, J.; Brouwer, L. R.; Grizzard, J.; Kim, R. J.; Matasar, M.; Shia, J.; Moskowitz, C. S.; Steingart, R.; Weinsaft, J. W.
Article Title: Late gadolinium enhancement cardiac magnetic resonance tissue characterization for cancer-associated cardiac masses: Metabolic and prognostic manifestations in relation to whole-body positron emission tomography
Abstract: Background Cardiac magnetic resonance ( CMR) differentiates neoplasm from thrombus via contrast enhancement; positron emission tomography ( PET) assesses metabolism. The relationship between CMR contrast enhancement and metabolism on PET is unknown. Methods and Results The population included 121 cancer patients undergoing CMR and 18F-fluorodeoxyglucose (18F- FDG) - PET , including 66 with cardiac masses and cancer-matched controls. Cardiac mass etiology (neoplasm, thrombus) on CMR was defined by late gadolinium enhancement; PET was read blinded to CMR for diagnostic performance, then colocalized to measure FDG avidity. Of CMR -evidenced thrombi (all nonenhancing), none were detected by PET . For neoplasm, PET yielded reasonable sensitivity (70-83%) and specificity (75-88%). Lesions undetected by PET were more likely to be highly mobile ( P=0.001) despite similar size ( P=0.33). Among nonmobile neoplasms, PET sensitivity varied in relation to extent of CMR -evidenced avascularity; detection of diffusely enhancing or mixed lesions was higher versus predominantly avascular neoplasms (87% versus 63%). Colocalized analyses demonstrated 2- to 4-fold higher FDG uptake in neoplasm versus thrombus ( P<0.001); FDG uptake decreased stepwise when neoplasms were partitioned based on extent of avascularity on late gadolinium enhancement CMR ( P≤0.001). Among patients with neoplasm, signal-to-noise ratio on late gadolinium enhancement CMR moderately correlated with standardized uptake values on PET ( r=0.42-0.49, P<0.05). Mortality was higher among patients with CMR -evidenced neoplasm versus controls (hazard ratio: 1.99 [95% CI, 1.1-3.6]; P=0.03) despite nonsignificant differences when partitioned via FDG avidity (hazard ratio: 1.56 [95% CI, 0.85-2.74]; P=0.16). Among FDG-positive neoplasms detected concordantly with CMR , mortality risk versus cancer-matched controls was equivalently increased (hazard ratio: 2.12 [95% CI, 1.01-4.44]; P=0.047). Conclusions CMR contrast enhancement provides a criterion for neoplasm that parallels FDG -evidenced metabolic activity and stratifies prognosis. Extent of tissue avascularity on late gadolinium enhancement CMR affects cardiac mass identification by FDG - PET .
Keywords: positron emission tomography; cardiac magnetic resonance; cardiac neoplasm; cardio‐oncology
Journal Title: Journal of the American Heart Association
Volume: 8
Issue: 10
ISSN: 2047-9980
Publisher: Wiley Blackwell  
Date Published: 2019-05-21
Start Page: e011709
Language: English
DOI: 10.1161/jaha.118.011709
PUBMED: 31072171
PROVIDER: scopus
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Josef J Fox
    46 Fox
  2. Richard M Steingart
    120 Steingart
  3. Chaya S. Moskowitz
    177 Moskowitz
  4. Jinru Shia
    475 Shia
  5. Matthew J Matasar
    134 Matasar
  6. Angel T Chan
    6 Chan