Computed Tomography Tissue Characterization of Pediatric Cardiac Tumor

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Pediatric left ventricular cardiac tumor (lipoma) with severe congenital mitral valve regurgitation and ventricular tachycardia (n=1). Intervention: Cardiac computed tomography (CT) with arterial and delayed enhancement acquisitions using iodixanol contrast vs. Cardiac magnetic resonance imaging (MRI). Primary outcome: Histological confirmation of cardiac tumor tissue characterization.

Q: What does this research mean for the field?

Cardiac CT with arterial and delayed enhancement protocols can accurately characterize pediatric cardiac tumors when cardiac MRI is non-diagnostic due to implantable cardioverter-defibrillator artifact. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Rafael Zonana Amkie; Amulya Buddhavarapu; Mehul D. Patel; Bihong Zhao; Dilachew A. Adebo

doi:10.1016/j.jaccas.2023.101962

July 25, 2023JACC Case ReportsOpen Access

Computed Tomography Tissue Characterization of Pediatric Cardiac Tumor

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Why the study?

Little is known about tissue characterization of cardiac tumors using dedicated cardiac CT protocols with delayed enhancement techniques in pediatric patients.

Can dedicated cardiac CT protocols with arterial and delayed acquisitions characterize cardiac tumors in pediatric patients?

Key Points

Describe the utility of arterial and delayed-enhancement cardiac computed tomography protocols for tissue characterization and anatomical assessment of a pediatric cardiac tumor when magnetic resonance imaging is precluded.
Evaluated a 12-year-old female presenting with ventricular tachycardia, congenital mitral regurgitation, an automated implantable cardioverter-defibrillator (AICD), and an indeterminate left ventricular mass after cardiac MRI failed due to metallic artifact.
Performed dual-source prospective electrocardiogram-gated cardiac CT using 1 mL/kg iodixanol at 3 mL/s followed by 0.3 mL/kg over 1 minute, acquiring early arterial images (35% to 70% of cardiac cycle) and delayed images (35% of cardiac cycle) after 9 minutes.
Early-phase CT showed a large, hypoattenuated mass with low Hounsfield units infiltrating the posterolateral left ventricular myocardium, showing no calcification or vascularity and an absent left circumflex coronary artery.
Delayed 9-minute CT demonstrated heterogeneous differential attenuation with enhancement consistent with fat attenuation admixed with fine fibrous septa, confirmed on surgical biopsy as a benign lipoma.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Can dedicated cardiac CT protocols with arterial and delayed acquisitions characterize cardiac tumors in pediatric patients?

P

Population

A 12-year-old female with a large left ventricular free wall tumor, severe congenital mitral valve regurgitation, ventricular tachycardia, and an automated implantable cardioverter-defibrillator precluding diagnostic cardiac MRI.

I

Intervention

Dedicated cardiac computed tomography (CT) protocols using arterial and delayed acquisitions

O

Outcome

Tissue characterization of the cardiac tumorsurrogate

Dedicated cardiac CT protocols with arterial and delayed acquisitions can be used for tissue characterization of cardiac tumors in pediatric patients.

Limitations

Single-patient case report
Clinicians have very limited experience in assessing cardiac tissue characterization with delayed enhancement CT techniques among children

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Implication

May support CT for cardiac tumor characterization when MRI is contraindicated in children; leaves open prospective validation before clinical adoption.

Abstract

Little is known about tissue characterization of cardiac tumors by dedicated cardiac computed tomography (CT) protocols in pediatric patients. We report using arterial and delayed CT acquisitions to characterize a large left ventricular free wall tumor in a 12-year-old female with congenital mitral insufficiency and an automatic implantable cardioverter defibrillator. (Level of Difficulty: Intermediate.)

Discussion

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Cite This Study

Amkie et al. (2023) conducted a case report in Pediatric left ventricular cardiac tumor (lipoma) with severe congenital mitral valve regurgitation and ventricular tachycardia (n=1). Cardiac computed tomography (CT) with arterial and delayed enhancement acquisitions using iodixanol contrast vs. Cardiac magnetic resonance imaging (MRI) was evaluated on Histological confirmation of cardiac tumor tissue characterization.

synapsesocial.com/papers/6a8db423d881876296cf92f0 https://doi.org/10.1016/j.jaccas.2023.101962

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Computed Tomography Tissue Characterization of Pediatric Cardiac Tumor

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Computed Tomography Tissue Characterization of Pediatric Cardiac Tumor

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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