Indian Academy of Echocardiography–Indian Association of Cardiac Imaging Expert Document on Multimodality Evaluation of Cardiac Masses

Cardiac masses comprise neoplastic and nonneoplastic lesions. Neoplastic lesions can be further classified as benign or malignant tumors, which may be primary or secondary. A structured, stepwise diagnostic algorithm that integrates clinical and epidemiological features with imaging characteristics and diagnostic scores can facilitate the differentiation of cardiac masses into pseudomasses, thrombus, and benign or malignant tumors. This approach has practical value in providing clinically actionable information for prognostic assessment and therapeutic decision-making. Echocardiography is an important first-line imaging modality and is deeply integrated into routine clinical workflows. However, cardiac magnetic resonance (CMR), with its unique tissue characterization capabilities, has emerged as the imaging modality with the highest diagnostic performance for characterization of cardiac masses, although histopathology remains the reference standard. In cases where CMR yields an equivocal or borderline probability of malignancy, the addition of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) can further improve diagnostic accuracy for malignant tumors. The 18 F-FDG PET/CT also provides valuable information regarding an extracardiac primary malignancy, identification of an optimal biopsy site, disease staging, and assessment of response to therapy.