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Late Enhancement of a Left Ventricular Cardiac Fibroma Assessed With Gadolinium-Enhanced Cardiovascular Magnetic Resonance

2005; Lippincott Williams & Wilkins; Volume: 112; Issue: 13 Linguagem: Inglês

10.1161/circulationaha.104.487231

1524-4539

Francesco De Cobelli, Antonio Esposito, Renata Mellone, Marco Papa, Tiziana Varisco, Roberto Besana, Alessandro Del Maschio,

Cardiac Structural Anomalies and Repair

HomeCirculationVol. 112, No. 13Late Enhancement of a Left Ventricular Cardiac Fibroma Assessed With Gadolinium-Enhanced Cardiovascular Magnetic Resonance Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBLate Enhancement of a Left Ventricular Cardiac Fibroma Assessed With Gadolinium-Enhanced Cardiovascular Magnetic Resonance Francesco De Cobelli, MD, Antonio Esposito, MD, Renata Mellone, MD, Marco Papa, MD, Tiziana Varisco, MD, Roberto Besana, MD and Alessandro del Maschio, MD Francesco De CobelliFrancesco De Cobelli From the Department of Radiology (F.D.C., A.E., R.M., A.d.M.) and Division of Cardiology (M.P.), San Raffaele Scientific Institute, and Pediatric and Neonatology Department, Desio Hospital (T.V., R.B.), Milan, Italy. , Antonio EspositoAntonio Esposito From the Department of Radiology (F.D.C., A.E., R.M., A.d.M.) and Division of Cardiology (M.P.), San Raffaele Scientific Institute, and Pediatric and Neonatology Department, Desio Hospital (T.V., R.B.), Milan, Italy. , Renata MelloneRenata Mellone From the Department of Radiology (F.D.C., A.E., R.M., A.d.M.) and Division of Cardiology (M.P.), San Raffaele Scientific Institute, and Pediatric and Neonatology Department, Desio Hospital (T.V., R.B.), Milan, Italy. , Marco PapaMarco Papa From the Department of Radiology (F.D.C., A.E., R.M., A.d.M.) and Division of Cardiology (M.P.), San Raffaele Scientific Institute, and Pediatric and Neonatology Department, Desio Hospital (T.V., R.B.), Milan, Italy. , Tiziana VariscoTiziana Varisco From the Department of Radiology (F.D.C., A.E., R.M., A.d.M.) and Division of Cardiology (M.P.), San Raffaele Scientific Institute, and Pediatric and Neonatology Department, Desio Hospital (T.V., R.B.), Milan, Italy. , Roberto BesanaRoberto Besana From the Department of Radiology (F.D.C., A.E., R.M., A.d.M.) and Division of Cardiology (M.P.), San Raffaele Scientific Institute, and Pediatric and Neonatology Department, Desio Hospital (T.V., R.B.), Milan, Italy. and Alessandro del MaschioAlessandro del Maschio From the Department of Radiology (F.D.C., A.E., R.M., A.d.M.) and Division of Cardiology (M.P.), San Raffaele Scientific Institute, and Pediatric and Neonatology Department, Desio Hospital (T.V., R.B.), Milan, Italy. Originally published27 Sep 2005https://doi.org/10.1161/CIRCULATIONAHA.104.487231Circulation. 2005;112:e242–e243A 4-year-old patient was referred to our department and underwent gadolinium-enhanced cardiovascular MR (CMR) because of a suspected left ventricular mass. The infant was referred for an ECG before dental surgery; ECG revealed negative T waves in leads D1, AVL, V4, V5, and V6. Echocardiography showed a heterogeneous mass of the left ventricular lateral wall inside the pericardial space, 4.0×2.0 cm in size, with reduced lateral wall motion. The global left ventricular function was normal.CMR was performed under sedation with a 1.5-T magnet (Gyroscan Intera Master, Philips Medical System) with a cardiac phased-array multicoil. First, "black-blood" multiplanar morphological (Figure 1A) without and with fat suppression and cine "bright blood" balanced fast field-echo images were obtained (Figure 1B). These images revealed a hypointense mass arising within the left ventricular free wall, suggestive of cardiac fibroma. Dynamic contrast-enhanced CMR perfusion images were acquired during gadolinium-DTPA (0.1 mmol/kg) injection; after 10 minutes, 3D segmented IR-GRE technique to evaluate the delayed enhancement phase (DECMR) adjusting inversion time (230 ms) to null normal myocardium was performed. In early perfusion phase, the tumor demonstrated no contrast enhancement (Figure 2), but in the delayed phase, the tumor showed intense enhancement with central hypointensity compared with normal myocardium (Figure 3A and 3B), suggesting the nature of fibroma. The explanation of this late hyperenhancement pattern on DECMR is that microscopically fibromas are a collection of fibroblasts interspersed among large amounts of collagen. It is known that gadolinium bound to DTPA diffuses into the interstitial space but not across cell membranes. In fibromas, there is a great extracellular space for gadolinium accumulation, and the distribution kinetics are slower than normal myocardium; these phenomena result in a delayed and persistently higher relative concentration of gadolinium with late enhancement. Download figureDownload PowerPointFigure 1. Black-blood (A) and bright-blood (B) long-axis 4-views show a large hypointense mass into the free wall of the left ventricle, suggestive of cardiac fibroma.Download figureDownload PowerPointFigure 2. Short-axis image in early perfusion phase after gadolinium injection shows the hypoperfused mass encircled by a thin layer of normal perfused myocardium.Download figureDownload PowerPointFigure 3. In the long-axis (A) and short-axis (B) postcontrast late enhancement images, the signal of normal myocardium is nulled, whereas the mass shows intense enhancement resulting from the accumulation of gadolinium, with little central hypointense area.With these CMR findings, the infant was diagnosed as having left ventricular fibroma, and he did not undergo endomyocardial biopsy and surgical excision because of the absence of symptoms and the high level of risk for the patient's life. At a 6-month follow-up, no changes in clinical symptoms and ECG signs were found; moreover, at an echocardiography performed at the same time, no changes of the mass were shown, thus confirming the benign nature of the lesion.FootnotesCorrespondence to Francesco De Cobelli, MD, Department of Radiology, San Raffaele Scientific Institute, Via Olgettina 60, Milano 20132, Italy. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Gravina M, Casavecchia G, Totaro A, Ieva R, Macarini L, Di Biase M and Brunetti N (2014) Left ventricular fibroma: What cardiac magnetic resonance imaging may add?, International Journal of Cardiology, 10.1016/j.ijcard.2014.07.072, 176:2, (e63-e65), Online publication date: 1-Sep-2014. Kothari P, Pestana R, Mesraoua R, Elchaki R, Khan K, Dannenberg A and Falcone D (2013) IL-6–Mediated Induction of Matrix Metalloproteinase-9 Is Modulated by JAK-Dependent IL-10 Expression in Macrophages, The Journal of Immunology, 10.4049/jimmunol.1301906, 192:1, (349-357), Online publication date: 1-Jan-2014. Esposito A, De Cobelli F, Ironi G, Marra P, Canu T, Mellone R and Del Maschio A (2014) CMR in Assessment of Cardiac Masses, JACC: Cardiovascular Imaging, 10.1016/j.jcmg.2013.11.008, 7:7, (733-736), Online publication date: 1-Jul-2014. 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Wang M, Crisostomo P, Markel T, Wang Y and Meldrum D (2008) Mechanisms of Sex Differences in TNFR2-Mediated Cardioprotection, Circulation, 10.1161/CIRCULATIONAHA.107.756890, 118:14_suppl_1, Online publication date: 30-Sep-2008. September 27, 2005Vol 112, Issue 13 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.104.487231PMID: 16186429 Originally publishedSeptember 27, 2005 PDF download Advertisement SubjectsComputerized Tomography (CT)Imaging