Accuracy of Cardiac Magnetic Resonance Imaging in Diagnosing Pediatric Cardiac Masses,JACC: Cardiovascular Imaging

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Accuracy of Cardiac Magnetic Resonance Imaging in Diagnosing Pediatric Cardiac Masses
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2021-08-18 , DOI: 10.1016/j.jcmg.2021.07.010
Rebecca S Beroukhim ₁ , Sunil Ghelani ₁ , Ravi Ashwath ₂ , Sowmya Balasubramanian ₃ , David M Biko ₄ , Sujatha Buddhe ₅ , M Jay Campbell ₆ , Russell Cross ₇ , Pierluigi Festa ₈ , Lindsay Griffin ₉ , Heynric Grotenhuis ₁₀ , Keren Hasbani ₁₁ , Sassan Hashemi ₁₂ , Sanjeet Hegde ₁₃ , Tarique Hussain ₁₄ , Supriya Jain ₁₅ , Maria Kiaffas ₁₆ , Shelby Kutty ₁₇ , Christopher Z Lam ₁₈ , Gabriela Liberato ₁₉ , Anthony Merlocco ₂₀ , Nilanjana Misra ₂₁ , Katie L Mowers ₂₂ , Juan Carlos Muniz ₂₃ , Arni Nutting ₂₄ , David A Parra ₂₅ , Jyoti K Patel ₂₆ , Antonio R Perez-Atayde ₁ , Deepa Prasad ₂₇ , Carlos F Rosental ₂₈ , Amee Shah ₂₉ , Margaret M Samyn ₃₀ , Lynn A Sleeper ₁ , Timothy Slesnick ₁₂ , Emanuela Valsangiacomo ₃₁ , Tal Geva ₁

Affiliation

Boston Children's Hospital, Boston, Massachusetts, USA.
University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA.
CS Mott Children's Hospital, Ann Arbor, Michigan, USA.
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Seattle Children's Hospital, Seattle, Washington, USA.
Duke Children's Hospital, Durham, North Carolina, USA.
Children's National Medical Center, Washington, DC, USA.
Fondazione G. Monasterio C.N.R. Regione Toscana, Pisa, Italy.
Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
University of Utrecht, Utrecht, the Netherlands.
Dell Children's Medical Center, Austin, Texas, USA.
Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Rady Children's Hospital San Diego, San Diego, California, USA.
Children's Medical Center Dallas, Dallas, Texas, USA.
Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA.
Children's Mercy Hospital, Kansas City, Missouri, USA.
Johns Hopkins Children's Center, Baltimore, Maryland, USA; Children's Hospital and Medical Center, Omaha, Nebraska, USA.
Hospital for Sick Children, Toronto, Canada.
Heart Institute, InCor, Sao Paulo, Brazil.
Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
Cohen Children's Medical Center of New York, Northwell Health, New Hyde Park, New York, USA.
CS Mott Children's Hospital, Ann Arbor, Michigan, USA; St Louis Children's Hospital, St Louis, Missouri, USA.
Nicklaus Children's Hospital, Miami, Florida, USA.
Medical University of South Carolina, Charleston, South Carolina, USA.
Vanderbilt Children's Hospital, Nashville, Tennessee, USA.
Riley Children's Hospital, Indianapolis, Indiana, USA.
Banner Children's Hospital, Mesa, Arizona, USA.
Hospital Pediatria Garrahan, Buenos Aires, Argentina.
Children's Hospital of New York, New York, New York, USA.
Medical Collect of Wisconsin/Children's Wisconsin, Milwaukee, Wisconsin, USA.
University Children's Hospital Zurich, Zurich, Switzerland.

Background

After diagnosis of a cardiac mass, clinicians must weigh the benefits and risks of ascertaining a tissue diagnosis. Limited data are available on the accuracy of previously developed noninvasive pediatric cardiac magnetic resonance (CMR)-based diagnostic criteria.

Objectives

The goals of this study were to: 1) evaluate the CMR characteristics of pediatric cardiac masses from a large international cohort; 2) test the accuracy of previously developed CMR-based diagnostic criteria; and 3) expand diagnostic criteria using new information.

Methods

CMR studies (children 0-18 years of age) with confirmatory histological and/or genetic diagnosis were analyzed by 2 reviewers, without knowledge of prior diagnosis. Diagnostic accuracy was graded as: 1) single correct diagnosis; 2) correct diagnosis among a differential; or 3) incorrect diagnosis.

Results

Of 213 cases, 174 (82%) had diagnoses that were represented in the previously published diagnostic criteria. In 70% of 174 cases, both reviewers achieved a single correct diagnosis (94% of fibromas, 71% of rhabdomyomas, and 50% of myxomas). When ≤2 differential diagnoses were included, both reviewers reached a correct diagnosis in 86% of cases. Of 29 malignant tumors, both reviewers indicated malignancy as a single diagnosis in 52% of cases. Including ≤2 differential diagnoses, both reviewers indicated malignancy in 83% of cases. Of 6 CMR sequences examined, acquisition of first-pass perfusion and late gadolinium enhancement were independently associated with a higher likelihood of a single correct diagnosis.

Conclusions

CMR of cardiac masses in children leads to an accurate diagnosis in most cases. A comprehensive imaging protocol is associated with higher diagnostic accuracy.

中文翻译：

心脏磁共振成像诊断儿童心脏肿块的准确性

背景

诊断出心脏肿块后，临床医生必须权衡确定组织诊断的益处和风险。关于先前开发的基于无创儿科心脏磁共振 (CMR) 的诊断标准的准确性的数据有限。

目标

本研究的目标是：1）评估来自大型国际队列的儿童心脏肿块的 CMR 特征； 2）测试先前开发的基于CMR的诊断标准的准确性； 3）利用新信息扩大诊断标准。

方法

具有确认性组织学和/或基因诊断的 CMR 研究（0-18 岁儿童）由 2 位评价者进行分析，且事先不了解诊断情况。诊断准确率分级为：1）单次正确诊断； 2）正确诊断之间的鉴别；或3）错误的诊断。

结果

在 213 例病例中，174 例（82%）的诊断符合先前发布的诊断标准。在 174 例病例中，70% 的患者均获得了单一正确诊断（94% 的纤维瘤、71% 的横纹肌瘤和 50% 的粘液瘤）。当纳入≤2个鉴别诊断时，两位评审员对86%的病例做出了正确诊断。在 29 种恶性肿瘤中，两位评审员均指出 52% 的病例单一诊断为恶性肿瘤。包括≤2个鉴别诊断在内，两位评价者均指出83%的病例为恶性肿瘤。在检查的 6 个 CMR 序列中，获得首过灌注和晚期钆增强与单一正确诊断的较高可能性独立相关。