Cardiac Myxomas Show Elevated Native T1, T2 Relaxation Time and ECV on Parametric CMR

Figures

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  Figure 1. MRI protocol. Different images of cardiac myxomas during cardiac magnetic resonance examination; (A) cine image in three chamber view; (B) T1 weighted image without fat suppression, myxoma having isointense signal; (C) T1 weighted image with fat suppression, myxoma also having isointense signal denoting no fat content in myxoma; (D) T2 weighted image without fat suppression, myxoma having hyperintense signal; (E) T2 mapping; (F) T1 mapping; (G) First pass perfusion; (H) Late gadolinium enhancement, myxomas showing heterogeneous pattern of delayed enhancement. The whole protocol takes ~45 min to complete.

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  Figure 2. (Case 1) Co-registration of LGE (lower image) and T1-mapping (upper image). Presence of LGE is defined as bright signal on LGE images (arrow). Where areas with and without LGE were discernible on mapping images of the same orientation, respective regions of interest where placed for differential measurements.

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  Figure 3. (Case 3). (A) Cine image, three chamber view showing the cardiac myxoma attached to the anterior mitral leaflet where the inhomogeneous nature can be appreciated. (B) Native T1 relaxation time mapping (C) T2 relaxation time mapping. (D) Macroscopic appearance of the smooth surfaced resected mass. (E) Cut surface of the mass with old and recent hemorrhages and cystic changes in the central portion. Histopathology, low magnification. (F) Hematoxylin/eosin stained section shows areas of hemorrhage (red) and cystic change within the cardiac myxoma. (G) Elastica van Gieson highlights the fibrous stroma in brown. (H) Alcian blue stain highlights myxoid matrix in blue. Histopathological examination showed a well-circumscribed mass with a hemorrhagic and gelatinous cut surface, composed of scattered stellate cells without significant nuclear atypia, which accumulate around vessels, set in a well-vascularized myxoid and fibrous stroma.

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  Figure 4. Native T1 Relaxation Times (in milliseconds) of myocardium and myxoma. Where areas with and without LGE were discernible, respective measurements were taken.

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  Figure 5. Extracellular volume fraction (ECV, in %) of myocardium and myxoma. Where areas with and without LGE were discernible, respective measurements were taken.

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  Figure 6. T2 Relaxation Times (in milliseconds) of myocardium and myxoma. Where areas with and without LGE were discernible, respective measurements were taken.