Risk stratification of cardiac metastases using late gadolinium enhancement cardiovascular magnetic resonance: Prognostic impact of hypo-enhancement evidenced tumor avascularity Journal Article
| Authors: | Chan, A. T.; Dinsfriend, W.; Kim, J.; Yum, B.; Sultana, R.; Klebanoff, C. A.; Plodkowski, A.; Perez Johnston, R.; Ginsberg, M. S.; Liu, J.; Kim, R. J.; Steingart, R.; Weinsaft, J. W. |
| Article Title: | Risk stratification of cardiac metastases using late gadolinium enhancement cardiovascular magnetic resonance: Prognostic impact of hypo-enhancement evidenced tumor avascularity |
| Abstract: | Background: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is widely used to identify cardiac neoplasms, for which diagnosis is predicated on enhancement stemming from lesion vascularity: Impact of contrast-enhancement pattern on clinical outcomes is unknown. The objective of this study was to determine whether cardiac metastasis (CMET) enhancement pattern on LGE-CMR impacts prognosis, with focus on heterogeneous lesion enhancement as a marker of tumor avascularity. Methods: Advanced (stage IV) systemic cancer patients with and without CMET matched (1:1) by cancer etiology underwent a standardized CMR protocol. CMET was identified via established LGE-CMR criteria based on lesion enhancement; enhancement pattern was further classified as heterogeneous (enhancing and non-enhancing components) or diffuse and assessed via quantitative (contrast-to-noise ratio (CNR); signal-to-noise ratio (SNR)) analyses. Embolic events and mortality were tested in relation to lesion location and contrast-enhancement pattern. Results: 224 patients were studied, including 112 patients with CMET and unaffected (CMET -) controls matched for systemic cancer etiology/stage. CMET enhancement pattern varied (53% heterogeneous, 47% diffuse). Quantitative analyses were consistent with lesion classification; CNR was higher and SNR lower in heterogeneously enhancing CMET (p < 0.001)—paralleled by larger size based on linear dimensions (p < 0.05). Contrast-enhancement pattern did not vary based on lesion location (p = NS). Embolic events were similar between patients with diffuse and heterogeneous lesions (p = NS) but varied by location: Patients with right-sided lesions had threefold more pulmonary emboli (20% vs. 6%, p = 0.02); those with left-sided lesions had lower rates equivalent to controls (4% vs. 5%, p = 1.00). Mortality was higher among patients with CMET (hazard ratio [HR] = 1.64 [CI 1.17–2.29], p = 0.004) compared to controls, but varied by contrast-enhancement pattern: Diffusely enhancing CMET had equivalent mortality to controls (p = 0.21) whereas prognosis was worse with heterogeneous CMET (p = 0.005) and more strongly predicted by heterogeneous enhancement (HR = 1.97 [CI 1.23–3.15], p = 0.005) than lesion size (HR = 1.11 per 10 cm [CI 0.53–2.33], p = 0.79). Conclusions: Contrast-enhancement pattern and location of CMET on CMR impacts prognosis. Embolic events vary by CMET location, with likelihood of PE greatest with right-sided lesions. Heterogeneous enhancement—a marker of tumor avascularity on LGE-CMR—is a novel marker of increased mortality risk. © 2021, The Author(s). |
| Keywords: | cardiovascular magnetic resonance; cardio-oncology; cardiac neoplasm |
| Journal Title: | Journal of Cardiovascular Magnetic Resonance |
| Volume: | 23 |
| ISSN: | 1097-6647 |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2021-04-05 |
| Start Page: | 42 |
| Language: | English |
| DOI: | 10.1186/s12968-021-00727-2 |
| PUBMED: | 33814005 |
| PROVIDER: | scopus |
| PMCID: | PMC8020547 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 May 2021 -- Source: Scopus |
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