MRT diagnosis of cardiac myxomas: Sequence evaluation and differential diagnosis.

Purpose: To evaluate native and contrast enhanced T-1-weighted spin (T-1-SE ), cine gradient echo (Cine-GE), and T-2-weighted turbo spin (T-2-TSE) sequ ences in the diagnosis and differential diagnosis of cardiac myxomas, Metho ds: 15 patients with echocardiographically suspected cardiac atrial myxomas underwent 0,5 T-MR imaging of the heart with native T-1-SE, contrast-enhan ced T-1-SE, Cine-GE, and T-2-TSE sequences. MR images were evaluated for si gnal intensity (51) and lesion's conspicuity. Results were confirmed histol ogically (14x) or by follow-up (1x). Results: MRI revealed myxomas in 9 pat ients, sarcomas in three patients, and thrombi in three patients. Lesion co nspicuity was better in Cine-CE and T-2-TSE compared with native and contra st-enhanced T-1-SE sequences. Myxomas were characterized by an intermediate 51 similar to myocardium in T-1-SE, high SI similar to water in T-2-TSE, a nd low to moderately high enhancement (range 19 - 75 %, mean 48 %). Conclus ion: Distinct SI characteristics together with anatomical-topographical fea tures (attachment to the interatrial septum, no infiltration of myocardium and vessels) are diagnostic for cardiac myxomas. Cine-GE and T-2-TSE sequen ces are the sequences of choice for detection of myxomas and other atrial m asses. T-2-TSE and contrast-enhanced T-1-weighted sequences are most useful for mass characterisation and differentiation between myxomas, malignant t umors, and thrombi.