Multimodal Cardiovascular Imaging of Cardiac Tumors

Primary cardiac tumors are rare. Myxoma and sarcoma are the most common types of benign and malignant cardiac tumors, respectively. Secondary cardiac tumors, the majority of which are metastases, are more common than primary tumors. The use of an appropriate combination of cardiovascular imaging techniques is necessary for the differential diagnosis of cardiac tumors and for preoperative examinations aimed at assessing tumor mobility and the positional relationship between the tumor and the surrounding normal structures, such as valves, papillary muscle, etc. The various components of cardiac tumors, such as fibrosis, lipids, hemorrhaging, necrosis, and degenerative changes, can be identified based on their signal intensity on magnetic resonance imaging (MRI), whereas cine-MRI is useful for assessing tumor mobility. Computed tomography is the optimal modality for identifying calcification, and intravenous contrast agent injection is useful for evaluating tumor vascularity. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) plays an important role in the differentiation of malignant tumors from benign ones. Malignant cells utilize more glucose than benign cells. Thus, malignant cardiac tumors exhibit more intense FDG uptake than benign tumors. PET/MRI scanners are a recently developed type of clinical imaging system that can obtain morphological, histopathological, functional, and metabolic information in a single session. To suppress physiological myocardial FDG uptake, long-term fasting; the injection of heparin; and the administration of a high fat, low carbohydrate diet can be employed before PET scans. Herein, we review the imaging features of cardiac tumors and present clinical images of cardiac diseases that were obtained at our institution.