Usefulness Of Contrast Echocardiography In Differential Diagnosing Cardiac Masses

ObjectivesTo assess the usefulness of contrast echocardiography in differential diagnosing cardiac masses.MethodsContrast echocardiography for 41 patients of cardiac mass.30 patients among the 41 cases had one of the following types of diagnosis as our gold standards:1. Pathological diagnosis for 22 cases (2 thrombus,12 benign tumors and 8 malignant tumors; Out of 8 malignant tumors,4 were primary and the other 4 were secondary malignancy); 2. Thrombus was diagnosed for 6 cases while TTE found disappearance or minimization of cardiac mass after anticoagulant therapy; 3. Malignant tumor was diagnosed for 2 cases while TTE found disappearance of cardiac mass after chemo-treatment. Contrast enhancement of cardiac mass was assessed visually, comparing with that in the adjacent myocardium:significant contrast enhancement, intensity higher than or equal to the adjacent myocardium; mild or partial contrast enhancement, intensity lower than the adjacent myocardium; or no contrast enhancement. Respectively, malignant tumors, benign tumors, and thrombus were diagnosed. The consistency between visual assessment diagnosis and gold standards were compared with Kappa statistic. ResultsAmong 30 cases with gold standard diagnosis,5 were present in LVA,1 in LVA and right ventricular apex(RVA),1 in left ventricle(LV),11 in LA,3 in right ventricle(RV),2 in right atrium(RA), and 6 in pericardium or paracadial region. Visual semi-quantitative diagnosis of contrast echocardiography:Thrombus, benign tumors and malignant tumors were diagnosed for 8,10 and 12 cases, separately. Except 2 highly vascular benign tumors (1 rhabdomyoma and 1 paraganglioma) were misdiagnosed as malignant tumors, the rest 28 cases matched gold standard diagnosis. Quantitative analysis of contrast echocardiography: 16 cases were suitable for quantitative analysis:10 cases were diagnosed as benign tumors or thrombus (Quantitative analysis could not differentiate the two); the rest 6 cases were diagnosed as malignant tumors. Quantitative analysis got the same 2 misdiagnosis as visual semi-quantitative diagnosis. Kappa value on visual semi-quantitative diagnosis of contrast echocardiography comparing with gold standard diagnosis was 0.899.ConclusionsThe characteristics of vascularity of cardiac mass can be accurately determined by the contrast enhancement level in diseased region through visual semi-quantitative analysis with contrast echocardiography. Contrast echocardiography can be mainly used in cardiac mass except thrombus that has been clearly diagnosed, especially for patients with ongoing or fore-past malignancy in other organs.