Diagnostic value of contrast enhanced echocardiography in cardiac masses

doi:10.3877/cma.j.issn.1672-6448.2019.10.006

Abstract

Abstract:

Objective

To investigate the value and accuracy of contrast enhanced echocardiography in the diagnosis of cardiac masses.

Methods

A total of 66 patients who were treated at Tongji Hospital of Huazhong University of Science and Technology from March 2013 to May 2018 were enrolled in the present study. Cardiac masses were discovered by echocardiography in each of the patients, and conventional echocardiography and contrast enhanced echocardiography were performed in all of the patients. The enhancement levels of cardiac masses and adjacent myocardium on contrast images were evaluated by visual inspection and quantitative analysis. On visual inspection, a cardiac mass with no enhancement was diagnosed as thrombus, a mass with partial and lesser enhancement than adjacent myocardium was diagnosed as benign tumor, while a mass with complete enhancement was diagnosed as malignant tumor. By quantitative analysis, the difference between a mass and adjacent myocardium (ΔA) was calculated using time-signal intensity curves. The sensitivity, specificity, and accuracy of ΔA in tissue characterization of cardiac masses were evaluated by ROC curve analysis. The final diagnoses of all cardiac masses were identified by validation methods.

Results

Using the gold standard methods, of the 66 patients, 15 were diagnosed with thrombi, 23 diagnosed with benign tumors, and 28 with malignant tumors. The sensitivity, specificity, and accuracy of visual inspection in differentiating thrombi, benign tumors, and malignant tumors were 100%, 100%, and 100%, 91%, 100%, and 97%, and 100%, 95%, and 97%, respectively. The sensitivity, specificity, and accuracy of ΔA in differentiating thrombi from other masses were 93%, 100%, and 95%, respectively (cutoff value=-3.21dB, AUC=0.978). The sensitivity, specificity, and accuracy of ΔA in differentiating malignant tumors from other masses were 100%, 97%, and 98%, respectively (cutoff value=0.45dB, AUC=0.997).

Conclusion

Both visual inspection and quantitative analysis of contrast enhanced echocardiography have a high sensitivity and specificity in differentiating between cardiac thrombi, benign tumors, and malignant tumors.

Key words: Echocardiography, Ultrasound contrast, Heart neoplasms, Thrombus

Qiaoying Tang, Youbin Deng, Xiaojun Bi, Jie Sun, Li Li, Jun Zhang. Diagnostic value of contrast enhanced echocardiography in cardiac masses[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(10): 742-748.

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References 21

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心脏占位病灶性质	例数	年龄（岁，±s）	性别（例，男/女）	病灶大小（cm²，±s）	病灶位置（例）	相关病史（例）
心脏占位病灶性质	例数	年龄（岁，±s）	性别（例，男/女）	病灶大小（cm²，±s）	病灶位置（例）	心脏外恶性肿瘤	心血管疾病
血栓	15	58.67±11.41	12/3	6.95±5.48	左心室心尖部（10），左心房（5）	肺癌（1）	心肌梗死（10），二尖瓣狭窄（3），房颤（1）
良性肿瘤	23	47.61±11.69	10/13	13.68±9.28	左心房（15），右心室（2），左心室（1），心包腔（2），左心室和右心室（1），左心房和右心室（1），右心房和心包腔（1）	乳腺癌（1），胫骨低分化肉瘤（1）	二尖瓣狭窄（1）
原发性恶性肿瘤	5	38.40±9.91	3/2	34.10±18.81	心包腔（2），右心室（1），右心房（1），左心房和右心房（1）	-	-
继发性恶性肿瘤	23	50.35±18.82	12/11	13.00±8.29	左心房（7），右心室（6），右心房（6），左心室（2），心包腔（1），肺动脉周边（1）	肺癌（5），纵隔肿瘤（4），消化道肿瘤（4），淋巴瘤（3），乳腺癌（2），肝癌（2），肾癌（1），甲状腺癌（1），卵巢癌（1）	-

心脏占位病灶性质	例数	年龄（岁，±s）	性别（例，男/女）	病灶大小（cm²，±s）	病灶位置（例）	相关病史（例）
心脏占位病灶性质	例数	年龄（岁，±s）	性别（例，男/女）	病灶大小（cm²，±s）	病灶位置（例）	心脏外恶性肿瘤	心血管疾病
血栓	15	58.67±11.41	12/3	6.95±5.48	左心室心尖部（10），左心房（5）	肺癌（1）	心肌梗死（10），二尖瓣狭窄（3），房颤（1）
良性肿瘤	23	47.61±11.69	10/13	13.68±9.28	左心房（15），右心室（2），左心室（1），心包腔（2），左心室和右心室（1），左心房和右心室（1），右心房和心包腔（1）	乳腺癌（1），胫骨低分化肉瘤（1）	二尖瓣狭窄（1）
原发性恶性肿瘤	5	38.40±9.91	3/2	34.10±18.81	心包腔（2），右心室（1），右心房（1），左心房和右心房（1）	-	-
继发性恶性肿瘤	23	50.35±18.82	12/11	13.00±8.29	左心房（7），右心室（6），右心房（6），左心室（2），心包腔（1），肺动脉周边（1）	肺癌（5），纵隔肿瘤（4），消化道肿瘤（4），淋巴瘤（3），乳腺癌（2），肝癌（2），肾癌（1），甲状腺癌（1），卵巢癌（1）	-

声学造影目测法	金标准			合计
声学造影目测法	血栓	良性肿瘤	恶性肿瘤	合计
血栓	15	0	0	15
良性肿瘤	0	21	0	21
恶性肿瘤	0	2	28	30
合计	15	23	28	66

声学造影目测法	金标准			合计
声学造影目测法	血栓	良性肿瘤	恶性肿瘤	合计
血栓	15	0	0	15
良性肿瘤	0	21	0	21
恶性肿瘤	0	2	28	30
合计	15	23	28	66

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