Myocardial Contrast Echocardiography And Transesophageal Echocardiography Assessing Cardiac Masses

BackgroundCardiac masses include benign tumors,malignant tumors(primary and secondary malignant tumors),thrombus,abscess,hematomas and so on.Patients with Cardiac thrombus are often associated with heart diseases and can be cured with effective anticoagulation.Surgical resection is preferred treatment for patients with cardiac benign tumors.Because of types of pathological types,patients with malignant tumor may select surgery,chemotherapy or radiotherapy.So,it is important to make an accurate diagnosis before select the appropriate treatment.Routine transthoracic echocardiography(TTE)is primary diagnostic modality for cardiac masses and can display its location,diameter,shape and so on.However differentiation between the different types of cardiac masses may be difficult.Recently,contrast enhanced ultrasonography have been applied to diagnose masses in liver,thyroid and breast and can make sure the vascularity.On the other hand,because of independent of acoustic window,obesity,lung ase,transesophageal echocardiography(TEE)can clearly display cardiac structure.Specially,real time three dimensional transesophageal echocardiography(RT3D TEE)can visually display cardiac and provide more accurate and ample information.Object1.To discuss the value of MCE(myocardial contrast echocardiography)in differentiating the cardiac masses;2.To explore the application of 2D TEE and RT3 D TEE in diagnosis of cardiac masses.Materials and methods1.Application of MCE in differentiating the cardiac massesSignatures of informed consent of patients [n=48(male: 26,female: 22),age range from 23 to 83 years old] with cardiac mass from July 2014 to November 2015 were obtained and divided into thrombus group,benign tumor group and malignant tumor group.TTE and MCE examination were performed using Philips iE33 equipped with 1~5MHz phased array transducer and relevant analysis software.Instruct patients with left side and collect the electrocardiogram.We observe the size,shape,location,echo and the relationship adjacent to tissues of masses by routine TTE.Then choose the appropriate section,activate the myocardial contrast mode,inject the Sonovue 2.5ml through peripheral vena,observe the enhancement of masses and myocardial,acquire time-intensity curve,A value,slope of curve and time to peak by the analysis software.The measurement data were expressed as means±SD,differences among groups were analyzed by two groups t-test.Enumeration data were expressed as absolute;differences among groups were analyzed by chi-square test using SPSS18.0 software.Statistical significance was reported as P<0.05 for 95% confidence.2.Application of TEE in diagnosing cardiac massesPatients [n=26(male: 11,female: 15),age range from 25 to 64 years old] with cardiac mass from November 2014 to November 2015 were obtained.2D TTE,2D TEE and RT3 D TEE examination were performed using Philips i E33 equipped with 1~5MHz and 2~7MHz phased array transducer and relevant analysis software.The patients are instructed to sign the informed consent,ambrosia beyond 8 hours,taking narcotic drugs before examination.Instruct patients with left side and collect the electrocardiogram.We observe the size,shape,tumor stalk,echo and the relationship adjacent to tissues of masses by 1~5MHz and 2~7MHz transducer,measure the related parameter,spin and incise the three dimensional imaging.The biggest diameter of masses were expressed as means±SD,differences among groups were analyzed by two groups t-test.Correlation test were analyzed by Pesrson correlation using SPSS18.0 software.Statistical significance was reported as P<0.05 for 95% confidence.Result1.Application of MCE in differentiating the cardiac massesBenign tumors,malignant tumors and thrombus are 27,17 and 4 cases respectively in 48 cases masses.27 benign tumors(27/48,56.3%)were confirmed by surgery,while 10 malignant tumors were confirmed by surgery,5 cases decreased after chemotherapy,2 cases confirmed by biopsy in 17 malignant tumor.4 cases thrombus were decreased after anticoagulant therapy.In 27 benign cardiac tumors,18 cases(18/27,66.7%)were with smooth boundaries,18 cases(18/27,66.7%)were homogeneously enhanced,22 cases(22/27,81.5%)showed lowly enhanced.In 17 malignant cardiac tumors,17 cases(17/17,100%)were with unsmooth boundaries and inhomogeneously enhanced,12 cases(12/17,70.59%)displayed highly enhanced.4 cases thrombus were no enhanced.Half-quantitative analysis,tumor A/myocardium A and slope of curve had significant difference in benign and malignant tumors(all P<0.05).2.Application of TEE in diagnosing cardiac massesBenign tumors are 15 cases confirmed by surgery,while malignant tumors are 5 cases of which 4 cases are confirmed by surgery and 1 case by PET/CT respectively.Other masses include 3 cases thrombus,2 cases crista terminalis diagnosed by TEE and 1 cases hematoma confirmed by surgery in 26 masses.8 cases(8/26,30.8%),20 cases(20/26,76.9%)and 14 cases(14/21,66.7%)are diagnosed respectively by 2D TEE,2D TEE and RT3 D TEE,cardiac CT.2D TEE can display tumor stalk,small thrombus and crista terminalis which 2D TTE can’t,define the boundary of masses,ensure the relation with surrounding structure.Based on 2D TEE,RT3 D TEE can visually assess mass shape,surface feature and relationship adjacent to tissue.Conclusion1.MCE can identify thrombus and tumor,while half-quantitative and quantitative analysis can help differentiate benign and malignant cardiac tumors.Unsmooth boundaries and inhomogeneous enhancement are most sensitive to diagnose the malignant tumor.It is more accurate to diagnose the typical myxoma by the routine ultrasound than MCE.Enhancement of tumor may correlate with the size,shape,texture,pathological pattern.MCE associating with routine echocardiography can improve diagnostic accuracy.2.Compared with TTE,TEE is more sensitive to assess the size,location,shape,surface feature and inner echo of mass.TEE can display the tumor stalk,crista terminalis and little thrombus which TTE can’t and define the boundary of masses,ensure the relation with surrounding structure.RT3 D TEE can distinctly allow visualization image and the relationship adjacent to tissue.