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MR Imaging of Cardiac Tumors¹

¹ From the British Heart Foundation Cardiac MRI Unit, Room 170, D Floor, Jubilee Wing, The General Infirmary, Leeds LS1 3EX, England. Received August 11, 2004; revision requested November 8 and received December 22; accepted January 3, 2005. All authors have no financial relationships to disclose. P.J.S. supported by a grant from the British Heart Foundation.

View larger version (159K): [in a new window]   Figure 1a.  Myxoma of the left atrium in a 70-year-old man who experienced multiple arterial embolic events. (a, b) Axial ECG-gated breath-hold T1-weighted (repetition time msec/echo time msec = 800/38) (a) and T2-weighted (1,600/120) (b) double IR fast SE images show a small myxoma (arrow in a) arising from the posterior wall of the left atrium (LA). The lesion has a heterogeneous appearance on the T1-weighted image (a) and almost homogeneous high signal intensity on the T2-weighted image (b). (c) Axial delayed phase ECG-gated breath-hold T1-weighted IR spoiled gradient-echo image (4.4/1.6, inversion time = 220 msec, 15° flip angle), obtained 20 minutes after administration of gadolinium contrast material, shows heterogeneous intense enhancement of the lesion with areas of delayed enhancement peripherally due to necrosis (arrows). LV = left ventricle.

 

View larger version (147K): [in a new window]   Figure 1b.  Myxoma of the left atrium in a 70-year-old man who experienced multiple arterial embolic events. (a, b) Axial ECG-gated breath-hold T1-weighted (repetition time msec/echo time msec = 800/38) (a) and T2-weighted (1,600/120) (b) double IR fast SE images show a small myxoma (arrow in a) arising from the posterior wall of the left atrium (LA). The lesion has a heterogeneous appearance on the T1-weighted image (a) and almost homogeneous high signal intensity on the T2-weighted image (b). (c) Axial delayed phase ECG-gated breath-hold T1-weighted IR spoiled gradient-echo image (4.4/1.6, inversion time = 220 msec, 15° flip angle), obtained 20 minutes after administration of gadolinium contrast material, shows heterogeneous intense enhancement of the lesion with areas of delayed enhancement peripherally due to necrosis (arrows). LV = left ventricle.

 

View larger version (150K): [in a new window]   Figure 1c.  Myxoma of the left atrium in a 70-year-old man who experienced multiple arterial embolic events. (a, b) Axial ECG-gated breath-hold T1-weighted (repetition time msec/echo time msec = 800/38) (a) and T2-weighted (1,600/120) (b) double IR fast SE images show a small myxoma (arrow in a) arising from the posterior wall of the left atrium (LA). The lesion has a heterogeneous appearance on the T1-weighted image (a) and almost homogeneous high signal intensity on the T2-weighted image (b). (c) Axial delayed phase ECG-gated breath-hold T1-weighted IR spoiled gradient-echo image (4.4/1.6, inversion time = 220 msec, 15° flip angle), obtained 20 minutes after administration of gadolinium contrast material, shows heterogeneous intense enhancement of the lesion with areas of delayed enhancement peripherally due to necrosis (arrows). LV = left ventricle.

 

View larger version (150K): [in a new window]   Figure 2a.  Myxoma of the left atrium in a 37-year-old woman with embolic phenomena of the lower limbs. (a, b) Axial ECG-gated breath-hold T1-weighted double IR fast SE images (632/40) show a large myxoma with a heterogeneous appearance (* in a). The lesion occupies the left atrium (LA), arises from the interatrial septum, and invades through the fossa ovalis into the right atrium (RA) (arrow in b). (c) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (667/40) shows heterogeneous intense enhancement of the lesion. (d) Four-chamber ECG-gated breath-hold SSFP image (3.2/1.6, 55° flip angle) shows that the myxoma is isointense relative to the blood pool. Arrows = susceptibility artifact due to a thrombus on the surface of the myxoma, LV = left ventricle, RA = right atrium.

 

View larger version (153K): [in a new window]   Figure 2b.  Myxoma of the left atrium in a 37-year-old woman with embolic phenomena of the lower limbs. (a, b) Axial ECG-gated breath-hold T1-weighted double IR fast SE images (632/40) show a large myxoma with a heterogeneous appearance (* in a). The lesion occupies the left atrium (LA), arises from the interatrial septum, and invades through the fossa ovalis into the right atrium (RA) (arrow in b). (c) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (667/40) shows heterogeneous intense enhancement of the lesion. (d) Four-chamber ECG-gated breath-hold SSFP image (3.2/1.6, 55° flip angle) shows that the myxoma is isointense relative to the blood pool. Arrows = susceptibility artifact due to a thrombus on the surface of the myxoma, LV = left ventricle, RA = right atrium.

 

View larger version (161K): [in a new window]   Figure 2c.  Myxoma of the left atrium in a 37-year-old woman with embolic phenomena of the lower limbs. (a, b) Axial ECG-gated breath-hold T1-weighted double IR fast SE images (632/40) show a large myxoma with a heterogeneous appearance (* in a). The lesion occupies the left atrium (LA), arises from the interatrial septum, and invades through the fossa ovalis into the right atrium (RA) (arrow in b). (c) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (667/40) shows heterogeneous intense enhancement of the lesion. (d) Four-chamber ECG-gated breath-hold SSFP image (3.2/1.6, 55° flip angle) shows that the myxoma is isointense relative to the blood pool. Arrows = susceptibility artifact due to a thrombus on the surface of the myxoma, LV = left ventricle, RA = right atrium.

 

View larger version (133K): [in a new window]   Figure 2d.  Myxoma of the left atrium in a 37-year-old woman with embolic phenomena of the lower limbs. (a, b) Axial ECG-gated breath-hold T1-weighted double IR fast SE images (632/40) show a large myxoma with a heterogeneous appearance (* in a). The lesion occupies the left atrium (LA), arises from the interatrial septum, and invades through the fossa ovalis into the right atrium (RA) (arrow in b). (c) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (667/40) shows heterogeneous intense enhancement of the lesion. (d) Four-chamber ECG-gated breath-hold SSFP image (3.2/1.6, 55° flip angle) shows that the myxoma is isointense relative to the blood pool. Arrows = susceptibility artifact due to a thrombus on the surface of the myxoma, LV = left ventricle, RA = right atrium.

 

View larger version (139K): [in a new window]   Figure 3a.  Pericardial lipoma in a 68-year-old woman. (a, b) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar (667/25) (a) and T2-weighted double IR fast SE (2,000/120) (b) images show a lipoma (arrows in a). The lesion appears bright on both images; note the brighter appearance of fat on the fast SE T2-weighted image (b) than would be expected on a standard SE image. * in a = adipose tissue in the right atrioventricular groove, LA = left atrium, RAA = right atrial appendage. (c) Axial ECG-gated breath-hold T1-weighted spectral presaturation IR image (667/15) shows equivalent suppression of signal in the lipoma and in the mediastinal and subcutaneous fat.

 

View larger version (138K): [in a new window]   Figure 3b.  Pericardial lipoma in a 68-year-old woman. (a, b) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar (667/25) (a) and T2-weighted double IR fast SE (2,000/120) (b) images show a lipoma (arrows in a). The lesion appears bright on both images; note the brighter appearance of fat on the fast SE T2-weighted image (b) than would be expected on a standard SE image. * in a = adipose tissue in the right atrioventricular groove, LA = left atrium, RAA = right atrial appendage. (c) Axial ECG-gated breath-hold T1-weighted spectral presaturation IR image (667/15) shows equivalent suppression of signal in the lipoma and in the mediastinal and subcutaneous fat.

 

View larger version (146K): [in a new window]   Figure 3c.  Pericardial lipoma in a 68-year-old woman. (a, b) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar (667/25) (a) and T2-weighted double IR fast SE (2,000/120) (b) images show a lipoma (arrows in a). The lesion appears bright on both images; note the brighter appearance of fat on the fast SE T2-weighted image (b) than would be expected on a standard SE image. * in a = adipose tissue in the right atrioventricular groove, LA = left atrium, RAA = right atrial appendage. (c) Axial ECG-gated breath-hold T1-weighted spectral presaturation IR image (667/15) shows equivalent suppression of signal in the lipoma and in the mediastinal and subcutaneous fat.

 

View larger version (141K): [in a new window]   Figure 4a.  Lipomatous infiltration of the interatrial septum in a 69-year-old woman with atrial fibrillation in whom an atrial mass was noted at transthoracic echocardiography. (a) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar image (800/25) shows a mass (arrows) with signal intensity similar to that of the subcutaneous and mediastinal fat. This is the classic appearance of lipomatous infiltration of the interatrial septum (although the mass is not dumbbell shaped). LA = left atrium, RA = right atrium, RV = right ventricle. (b) Axial T1-weighted spectral pre-saturation with IR fat-suppressed image (800/25) shows suppression of signal in the mass. AA = aorta.

 

View larger version (141K): [in a new window]   Figure 4b.  Lipomatous infiltration of the interatrial septum in a 69-year-old woman with atrial fibrillation in whom an atrial mass was noted at transthoracic echocardiography. (a) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar image (800/25) shows a mass (arrows) with signal intensity similar to that of the subcutaneous and mediastinal fat. This is the classic appearance of lipomatous infiltration of the interatrial septum (although the mass is not dumbbell shaped). LA = left atrium, RA = right atrium, RV = right ventricle. (b) Axial T1-weighted spectral pre-saturation with IR fat-suppressed image (800/25) shows suppression of signal in the mass. AA = aorta.

 

View larger version (122K): [in a new window]   Figure 5a.  Papillary fibroelastoma of the mitral valve in an 80-year-old woman who presented with embolic events. Diastolic (a) and systolic (b) coronal vertical long-axis ECG-gated breath-hold cine gradient-echo images (8.1/4.9, 35° flip angle) and axial four-chamber image (7.8/4.6, 35° flip angle) (c) show a pedunculated low-signal-intensity mass (arrow) arising from the atrial surface of the posterior mitral leaflet. Note the absence of a turbulent jet in the left atrium on the systolic image (b); this finding implies that there is no significant associated mitral regurgitation. LV = left ventricle.

 

View larger version (124K): [in a new window]   Figure 5b.  Papillary fibroelastoma of the mitral valve in an 80-year-old woman who presented with embolic events. Diastolic (a) and systolic (b) coronal vertical long-axis ECG-gated breath-hold cine gradient-echo images (8.1/4.9, 35° flip angle) and axial four-chamber image (7.8/4.6, 35° flip angle) (c) show a pedunculated low-signal-intensity mass (arrow) arising from the atrial surface of the posterior mitral leaflet. Note the absence of a turbulent jet in the left atrium on the systolic image (b); this finding implies that there is no significant associated mitral regurgitation. LV = left ventricle.

 

View larger version (142K): [in a new window]   Figure 5c.  Papillary fibroelastoma of the mitral valve in an 80-year-old woman who presented with embolic events. Diastolic (a) and systolic (b) coronal vertical long-axis ECG-gated breath-hold cine gradient-echo images (8.1/4.9, 35° flip angle) and axial four-chamber image (7.8/4.6, 35° flip angle) (c) show a pedunculated low-signal-intensity mass (arrow) arising from the atrial surface of the posterior mitral leaflet. Note the absence of a turbulent jet in the left atrium on the systolic image (b); this finding implies that there is no significant associated mitral regurgitation. LV = left ventricle.

 

View larger version (142K): [in a new window]   Figure 6a.  Primary cardiac angiosarcoma in a 25-year-old woman with leg swelling, abdominal pain, bloating, and dyspnea. (a) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar image (600/25) shows a large heterogeneous mass (straight arrows) arising from the right atrial free wall. The mass is predominantly isointense relative to the myocardium but has some areas of increased signal intensity (curved arrow), which are most likely due to localized hemorrhage. LV = left ventricle, RV = right ventricle. (b, c) Axial ECG-gated breath-hold T2-weighted double IR fast SE (1,895/120) (b) and fat-suppressed T2-weighted spectral presaturation with IR (1,895/120) (c) images show the large, hyperintense, water-rich mass. Note the presence of a concurrent left pleural effusion (* in b).

 

View larger version (138K): [in a new window]   Figure 6b.  Primary cardiac angiosarcoma in a 25-year-old woman with leg swelling, abdominal pain, bloating, and dyspnea. (a) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar image (600/25) shows a large heterogeneous mass (straight arrows) arising from the right atrial free wall. The mass is predominantly isointense relative to the myocardium but has some areas of increased signal intensity (curved arrow), which are most likely due to localized hemorrhage. LV = left ventricle, RV = right ventricle. (b, c) Axial ECG-gated breath-hold T2-weighted double IR fast SE (1,895/120) (b) and fat-suppressed T2-weighted spectral presaturation with IR (1,895/120) (c) images show the large, hyperintense, water-rich mass. Note the presence of a concurrent left pleural effusion (* in b).

 

View larger version (126K): [in a new window]   Figure 6c.  Primary cardiac angiosarcoma in a 25-year-old woman with leg swelling, abdominal pain, bloating, and dyspnea. (a) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar image (600/25) shows a large heterogeneous mass (straight arrows) arising from the right atrial free wall. The mass is predominantly isointense relative to the myocardium but has some areas of increased signal intensity (curved arrow), which are most likely due to localized hemorrhage. LV = left ventricle, RV = right ventricle. (b, c) Axial ECG-gated breath-hold T2-weighted double IR fast SE (1,895/120) (b) and fat-suppressed T2-weighted spectral presaturation with IR (1,895/120) (c) images show the large, hyperintense, water-rich mass. Note the presence of a concurrent left pleural effusion (* in b).

 

View larger version (158K): [in a new window]   Figure 7a.  Primary cardiac angiosarcoma in a 55-year-old man with weight loss, dyspnea, and peripheral edema. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (769/38) shows a large, heterogeneous, isointense mass that originates in and almost completely obliterates the right atrium. The mass contains subtle areas of increased signal intensity (arrows), which are due to hemorrhage. (b) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,538/120) shows that the mass (arrows) is heterogeneously hyperintense with areas of low signal intensity, which correspond to necrotic areas. CS = coronary sinus, IVC = inferior vena cava, RV = right ventricle. (c) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (769/38) shows marked enhancement of the mass with obvious areas of poor enhancement (*), which are due to focal necrosis. (d) Axial four-chamber ECG-gated breath-hold SSFP image (3/1.5, 55° flip angle) shows the angiosarcoma as a large slightly hyperintense mass arising from the right atrial free wall. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

 

View larger version (158K): [in a new window]   Figure 7b.  Primary cardiac angiosarcoma in a 55-year-old man with weight loss, dyspnea, and peripheral edema. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (769/38) shows a large, heterogeneous, isointense mass that originates in and almost completely obliterates the right atrium. The mass contains subtle areas of increased signal intensity (arrows), which are due to hemorrhage. (b) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,538/120) shows that the mass (arrows) is heterogeneously hyperintense with areas of low signal intensity, which correspond to necrotic areas. CS = coronary sinus, IVC = inferior vena cava, RV = right ventricle. (c) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (769/38) shows marked enhancement of the mass with obvious areas of poor enhancement (*), which are due to focal necrosis. (d) Axial four-chamber ECG-gated breath-hold SSFP image (3/1.5, 55° flip angle) shows the angiosarcoma as a large slightly hyperintense mass arising from the right atrial free wall. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

 

View larger version (154K): [in a new window]   Figure 7c.  Primary cardiac angiosarcoma in a 55-year-old man with weight loss, dyspnea, and peripheral edema. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (769/38) shows a large, heterogeneous, isointense mass that originates in and almost completely obliterates the right atrium. The mass contains subtle areas of increased signal intensity (arrows), which are due to hemorrhage. (b) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,538/120) shows that the mass (arrows) is heterogeneously hyperintense with areas of low signal intensity, which correspond to necrotic areas. CS = coronary sinus, IVC = inferior vena cava, RV = right ventricle. (c) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (769/38) shows marked enhancement of the mass with obvious areas of poor enhancement (*), which are due to focal necrosis. (d) Axial four-chamber ECG-gated breath-hold SSFP image (3/1.5, 55° flip angle) shows the angiosarcoma as a large slightly hyperintense mass arising from the right atrial free wall. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

 

View larger version (141K): [in a new window]   Figure 7d.  Primary cardiac angiosarcoma in a 55-year-old man with weight loss, dyspnea, and peripheral edema. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (769/38) shows a large, heterogeneous, isointense mass that originates in and almost completely obliterates the right atrium. The mass contains subtle areas of increased signal intensity (arrows), which are due to hemorrhage. (b) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,538/120) shows that the mass (arrows) is heterogeneously hyperintense with areas of low signal intensity, which correspond to necrotic areas. CS = coronary sinus, IVC = inferior vena cava, RV = right ventricle. (c) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (769/38) shows marked enhancement of the mass with obvious areas of poor enhancement (*), which are due to focal necrosis. (d) Axial four-chamber ECG-gated breath-hold SSFP image (3/1.5, 55° flip angle) shows the angiosarcoma as a large slightly hyperintense mass arising from the right atrial free wall. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

 

View larger version (143K): [in a new window]   Figure 8a.  Primary cardiac rhabdomyosarcoma in a 71-year-old man with weight loss, sweating, and worsening dyspnea. (a, b) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar images (923/25) (b obtained cephalad to a) show an isointense mass arising from the myocardial wall of the right ventricular outflow tract (arrow in a) with a large cavitating metastasis in the apical segment of the left lower lobe (arrow in b). (c) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,846/120) shows that the mass (arrow) has a more heterogeneous appearance, with areas of high signal intensity. (d) Sagittal ECG-gated breath-hold cine gradient-echo image (8/4.8, 35° flip angle) shows that the mass (arrowheads) is isointense relative to the adjacent infiltrated myocardium. The arrow indicates the pulmonary metastasis. LV = left ventricle.

 

View larger version (141K): [in a new window]   Figure 8b.  Primary cardiac rhabdomyosarcoma in a 71-year-old man with weight loss, sweating, and worsening dys-pnea. (a, b) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar images (923/25) (b obtained cephalad to a) show an isointense mass arising from the myocardial wall of the right ventricular outflow tract (arrow in a) with a large cavitating metastasis in the apical segment of the left lower lobe (arrow in b). (c) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,846/120) shows that the mass (arrow) has a more heterogeneous appearance, with areas of high signal intensity. (d) Sagittal ECG-gated breath-hold cine gradient-echo image (8/4.8, 35° flip angle) shows that the mass (arrowheads) is isointense relative to the adjacent infiltrated myocardium. The arrow indicates the pulmonary metastasis. LV = left ventricle.

 

View larger version (141K): [in a new window]   Figure 8c.  Primary cardiac rhabdomyosarcoma in a 71-year-old man with weight loss, sweating, and worsening dys-pnea. (a, b) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar images (923/25) (b obtained cephalad to a) show an isointense mass arising from the myocardial wall of the right ventricular outflow tract (arrow in a) with a large cavitating metastasis in the apical segment of the left lower lobe (arrow in b). (c) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,846/120) shows that the mass (arrow) has a more heterogeneous appearance, with areas of high signal intensity. (d) Sagittal ECG-gated breath-hold cine gradient-echo image (8/4.8, 35° flip angle) shows that the mass (arrowheads) is isointense relative to the adjacent infiltrated myocardium. The arrow indicates the pulmonary metastasis. LV = left ventricle.

 

View larger version (136K): [in a new window]   Figure 8d.  Primary cardiac rhabdomyosarcoma in a 71-year-old man with weight loss, sweating, and worsening dys-pnea. (a, b) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar images (923/25) (b obtained cephalad to a) show an isointense mass arising from the myocardial wall of the right ventricular outflow tract (arrow in a) with a large cavitating metastasis in the apical segment of the left lower lobe (arrow in b). (c) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,846/120) shows that the mass (arrow) has a more heterogeneous appearance, with areas of high signal intensity. (d) Sagittal ECG-gated breath-hold cine gradient-echo image (8/4.8, 35° flip angle) shows that the mass (arrowheads) is isointense relative to the adjacent infiltrated myocardium. The arrow indicates the pulmonary metastasis. LV = left ventricle.

 

View larger version (165K): [in a new window]   Figure 9a.  Metastases from an abdominal islet cell tumor in a 72-year-old woman with chest pain and palpitations. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (706/38) shows a hyperintense mass (arrow) infiltrating the interatrial septum. LV = left ventricle, RA = right atrium, RV = right ventricle. (b) Coronal ECG-gated breath-hold T2-weighted double IR fast SE image (1,412/100) shows extensive infiltration of the right side of the heart by a hyperintense tumor mass (arrows). Note the large skeletal metastasis in the neck of the right humerus (*). (c) Axial four-chamber ECG-gated breath-hold SSFP image (3/1.5, 55° flip angle) shows the metastasis in the interatrial septum (black arrow) and a metastasis in the lateral wall of the left ventricle (LV) (white arrow). Note that the tumors are isointense relative to the adjacent myocardium. LA = left atrium, RA = right atrium. (d) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (706/38) shows heterogeneous enhancement of the metastases noted in c (arrows).

 

View larger version (136K): [in a new window]   Figure 9b.  Metastases from an abdominal islet cell tumor in a 72-year-old woman with chest pain and palpitations. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (706/38) shows a hyperintense mass (arrow) infiltrating the interatrial septum. LV = left ventricle, RA = right atrium, RV = right ventricle. (b) Coronal ECG-gated breath-hold T2-weighted double IR fast SE image (1,412/100) shows extensive infiltration of the right side of the heart by a hyperintense tumor mass (arrows). Note the large skeletal metastasis in the neck of the right humerus (*). (c) Axial four-chamber ECG-gated breath-hold SSFP image (3/1.5, 55° flip angle) shows the metastasis in the interatrial septum (black arrow) and a metastasis in the lateral wall of the left ventricle (LV) (white arrow). Note that the tumors are isointense relative to the adjacent myocardium. LA = left atrium, RA = right atrium. (d) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (706/38) shows heterogeneous enhancement of the metastases noted in c (arrows).

 

View larger version (110K): [in a new window]   Figure 9c.  Metastases from an abdominal islet cell tumor in a 72-year-old woman with chest pain and palpitations. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (706/38) shows a hyperintense mass (arrow) infiltrating the interatrial septum. LV = left ventricle, RA = right atrium, RV = right ventricle. (b) Coronal ECG-gated breath-hold T2-weighted double IR fast SE image (1,412/100) shows extensive infiltration of the right side of the heart by a hyperintense tumor mass (arrows). Note the large skeletal metastasis in the neck of the right humerus (*). (c) Axial four-chamber ECG-gated breath-hold SSFP image (3/1.5, 55° flip angle) shows the metastasis in the interatrial septum (black arrow) and a metastasis in the lateral wall of the left ventricle (LV) (white arrow). Note that the tumors are isointense relative to the adjacent myocardium. LA = left atrium, RA = right atrium. (d) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (706/38) shows heterogeneous enhancement of the metastases noted in c (arrows).

 

View larger version (161K): [in a new window]   Figure 9d.  Metastases from an abdominal islet cell tumor in a 72-year-old woman with chest pain and palpitations. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (706/38) shows a hyperintense mass (arrow) infiltrating the interatrial septum. LV = left ventricle, RA = right atrium, RV = right ventricle. (b) Coronal ECG-gated breath-hold T2-weighted double IR fast SE image (1,412/100) shows extensive infiltration of the right side of the heart by a hyperintense tumor mass (arrows). Note the large skeletal metastasis in the neck of the right humerus (*). (c) Axial four-chamber ECG-gated breath-hold SSFP image (3/1.5, 55° flip angle) shows the metastasis in the interatrial septum (black arrow) and a metastasis in the lateral wall of the left ventricle (LV) (white arrow). Note that the tumors are isointense relative to the adjacent myocardium. LA = left atrium, RA = right atrium. (d) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (706/38) shows heterogeneous enhancement of the metastases noted in c (arrows).

 

View larger version (147K): [in a new window]   Figure 10a.  Non–small cell bronchogenic carcinoma in a 59-year-old woman with chest pain and atrial fibrillation. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (667/38) shows a large homogeneous mass that occupies most of the middle lobe of the right lung, involves the chest wall, and invades the left atrium (LA) via the right pulmonary veins (arrow). (b, c) Coronal ECG-gated breath-hold T2-weighted double IR fast SE (1,333/ 120) (b) and spectral presaturation with IR (c) images show the hyperintense mass invading the left atrium (LA) via the right superior pulmonary vein (arrow in b). (d) Axial four-chamber ECG-gated breath-hold T1-weighted cine gradient-echo image (3.3/1.6, 15° flip angle), obtained immediately after injection of gadolinium contrast material, shows first-pass perfusion of the tumor. Note the peripheral enhancement (white arrow) and the large area of central and edge necrosis (black arrow) in the portion of the tumor within the left atrium. LV = left ventricle. (e) Axial delayed phase ECG-gated breath-hold T1-weighted spoiled gradient-echo image (4.8/1.9, inversion time = 220 msec, 15° flip angle), obtained 20 minutes after injection of gadolinium contrast material, shows a heterogeneous pattern of contrast material washout. There is increased signal intensity within the areas in d that were suggestive of necrosis (arrow). LV = left ventricle, RV = right ventricle.

 

View larger version (162K): [in a new window]   Figure 10b.  Non–small cell bronchogenic carcinoma in a 59-year-old woman with chest pain and atrial fibrillation. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (667/38) shows a large homogeneous mass that occupies most of the middle lobe of the right lung, involves the chest wall, and invades the left atrium (LA) via the right pulmonary veins (arrow). (b, c) Coronal ECG-gated breath-hold T2-weighted double IR fast SE (1,333/ 120) (b) and spectral presaturation with IR (c) images show the hyperintense mass invading the left atrium (LA) via the right superior pulmonary vein (arrow in b). (d) Axial four-chamber ECG-gated breath-hold T1-weighted cine gradient-echo image (3.3/1.6, 15° flip angle), obtained immediately after injection of gadolinium contrast material, shows first-pass perfusion of the tumor. Note the peripheral enhancement (white arrow) and the large area of central and edge necrosis (black arrow) in the portion of the tumor within the left atrium. LV = left ventricle. (e) Axial delayed phase ECG-gated breath-hold T1-weighted spoiled gradient-echo image (4.8/1.9, inversion time = 220 msec, 15° flip angle), obtained 20 minutes after injection of gadolinium contrast material, shows a heterogeneous pattern of contrast material washout. There is increased signal intensity within the areas in d that were suggestive of necrosis (arrow). LV = left ventricle, RV = right ventricle.

 

View larger version (169K): [in a new window]   Figure 10c.  Non–small cell bronchogenic carcinoma in a 59-year-old woman with chest pain and atrial fibrillation. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (667/38) shows a large homogeneous mass that occupies most of the middle lobe of the right lung, involves the chest wall, and invades the left atrium (LA) via the right pulmonary veins (arrow). (b, c) Coronal ECG-gated breath-hold T2-weighted double IR fast SE (1,333/ 120) (b) and spectral presaturation with IR (c) images show the hyperintense mass invading the left atrium (LA) via the right superior pulmonary vein (arrow in b). (d) Axial four-chamber ECG-gated breath-hold T1-weighted cine gradient-echo image (3.3/1.6, 15° flip angle), obtained immediately after injection of gadolinium contrast material, shows first-pass perfusion of the tumor. Note the peripheral enhancement (white arrow) and the large area of central and edge necrosis (black arrow) in the portion of the tumor within the left atrium. LV = left ventricle. (e) Axial delayed phase ECG-gated breath-hold T1-weighted spoiled gradient-echo image (4.8/1.9, inversion time = 220 msec, 15° flip angle), obtained 20 minutes after injection of gadolinium contrast material, shows a heterogeneous pattern of contrast material washout. There is increased signal intensity within the areas in d that were suggestive of necrosis (arrow). LV = left ventricle, RV = right ventricle.

 

View larger version (137K): [in a new window]   Figure 10d.  Non–small cell bronchogenic carcinoma in a 59-year-old woman with chest pain and atrial fibrillation. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (667/38) shows a large homogeneous mass that occupies most of the middle lobe of the right lung, involves the chest wall, and invades the left atrium (LA) via the right pulmonary veins (arrow). (b, c) Coronal ECG-gated breath-hold T2-weighted double IR fast SE (1,333/ 120) (b) and spectral presaturation with IR (c) images show the hyperintense mass invading the left atrium (LA) via the right superior pulmonary vein (arrow in b). (d) Axial four-chamber ECG-gated breath-hold T1-weighted cine gradient-echo image (3.3/1.6, 15° flip angle), obtained immediately after injection of gadolinium contrast material, shows first-pass perfusion of the tumor. Note the peripheral enhancement (white arrow) and the large area of central and edge necrosis (black arrow) in the portion of the tumor within the left atrium. LV = left ventricle. (e) Axial delayed phase ECG-gated breath-hold T1-weighted spoiled gradient-echo image (4.8/1.9, inversion time = 220 msec, 15° flip angle), obtained 20 minutes after injection of gadolinium contrast material, shows a heterogeneous pattern of contrast material washout. There is increased signal intensity within the areas in d that were suggestive of necrosis (arrow). LV = left ventricle, RV = right ventricle.

 

View larger version (158K): [in a new window]   Figure 10e.  Non–small cell bronchogenic carcinoma in a 59-year-old woman with chest pain and atrial fibrillation. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (667/38) shows a large homogeneous mass that occupies most of the middle lobe of the right lung, involves the chest wall, and invades the left atrium (LA) via the right pulmonary veins (arrow). (b, c) Coronal ECG-gated breath-hold T2-weighted double IR fast SE (1,333/ 120) (b) and spectral presaturation with IR (c) images show the hyperintense mass invading the left atrium (LA) via the right superior pulmonary vein (arrow in b). (d) Axial four-chamber ECG-gated breath-hold T1-weighted cine gradient-echo image (3.3/1.6, 15° flip angle), obtained immediately after injection of gadolinium contrast material, shows first-pass perfusion of the tumor. Note the peripheral enhancement (white arrow) and the large area of central and edge necrosis (black arrow) in the portion of the tumor within the left atrium. LV = left ventricle. (e) Axial delayed phase ECG-gated breath-hold T1-weighted spoiled gradient-echo image (4.8/1.9, inversion time = 220 msec, 15° flip angle), obtained 20 minutes after injection of gadolinium contrast material, shows a heterogeneous pattern of contrast material washout. There is increased signal intensity within the areas in d that were suggestive of necrosis (arrow). LV = left ventricle, RV = right ventricle.

 

View larger version (169K): [in a new window]   Figure 11a.  Direct venous extension of a left-sided renal cell tumor in a 69-year-old woman with dyspnea and occasional near syncope. The tumor extension was noted at nephrectomy. Coronal (a) and axial (b) nonenhanced ECG-gated breath-hold T1-weighted SE echo-planar images (652/34) show that the entire left renal vein and abdominal inferior vena cava are filled by a mass (arrows in a), which extends into the right atrium (RA) (arrows in b). The tumor is isointense relative to the myocardium and hypointense relative to the adjacent liver.

 

View larger version (174K): [in a new window]   Figure 11b.  Direct venous extension of a left-sided renal cell tumor in a 69-year-old woman with dyspnea and occasional near syncope. The tumor extension was noted at nephrectomy. Coronal (a) and axial (b) nonenhanced ECG-gated breath-hold T1-weighted SE echo-planar images (652/34) show that the entire left renal vein and abdominal inferior vena cava are filled by a mass (arrows in a), which extends into the right atrium (RA) (arrows in b). The tumor is isointense relative to the myocardium and hypointense relative to the adjacent liver.

 

View larger version (107K): [in a new window]   Figure 12a.  Right atrial thrombus in a 68-year-old man with dyspnea and atrial fibrillation. At transthoracic echocardiography, there was apparent thickening of the right ventricular free wall. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (857/26) shows a predominantly hyperintense mass (arrows) in the right atrium (RA) with an area of reduced signal intensity and a central area of signal void. AO = aorta, LA = left atrium, RVOT = right ventricular outflow tract. (b) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,500/80) shows that the mass has a more heterogeneous appearance with similar areas of reduced signal intensity and signal void. (c) Axial ECG-gated breath-hold T1-weighted spectral presaturation with IR image (857/26) shows that the mass has almost uniform high signal intensity. (d) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (857/26) shows homogeneous enhancement of the surface of the thrombus. (e) Axial ECG-gated breath-hold SSFP image (3/1.5, 50° flip angle) shows the thrombus (arrows) as a subtle area of reduced signal intensity compared with that of the adjacent blood. Note the lack of infiltration of neighboring structures on all images. The imaging results were thought to be consistent with an organized subacute thrombus. Repeat imaging 3 months later showed evidence of further liquefaction with no increase in size.

 

View larger version (123K): [in a new window]   Figure 12b.  Right atrial thrombus in a 68-year-old man with dyspnea and atrial fibrillation. At transthoracic echocardiography, there was apparent thickening of the right ventricular free wall. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (857/26) shows a predominantly hyperintense mass (arrows) in the right atrium (RA) with an area of reduced signal intensity and a central area of signal void. AO = aorta, LA = left atrium, RVOT = right ventricular outflow tract. (b) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,500/80) shows that the mass has a more heterogeneous appearance with similar areas of reduced signal intensity and signal void. (c) Axial ECG-gated breath-hold T1-weighted spectral presaturation with IR image (857/26) shows that the mass has almost uniform high signal intensity. (d) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (857/26) shows homogeneous enhancement of the surface of the thrombus. (e) Axial ECG-gated breath-hold SSFP image (3/1.5, 50° flip angle) shows the thrombus (arrows) as a subtle area of reduced signal intensity compared with that of the adjacent blood. Note the lack of infiltration of neighboring structures on all images. The imaging results were thought to be consistent with an organized subacute thrombus. Repeat imaging 3 months later showed evidence of further liquefaction with no increase in size.

 

View larger version (124K): [in a new window]   Figure 12c.  Right atrial thrombus in a 68-year-old man with dyspnea and atrial fibrillation. At transthoracic echocardiography, there was apparent thickening of the right ventricular free wall. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (857/26) shows a predominantly hyperintense mass (arrows) in the right atrium (RA) with an area of reduced signal intensity and a central area of signal void. AO = aorta, LA = left atrium, RVOT = right ventricular outflow tract. (b) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,500/80) shows that the mass has a more heterogeneous appearance with similar areas of reduced signal intensity and signal void. (c) Axial ECG-gated breath-hold T1-weighted spectral presaturation with IR image (857/26) shows that the mass has almost uniform high signal intensity. (d) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (857/26) shows homogeneous enhancement of the surface of the thrombus. (e) Axial ECG-gated breath-hold SSFP image (3/1.5, 50° flip angle) shows the thrombus (arrows) as a subtle area of reduced signal intensity compared with that of the adjacent blood. Note the lack of infiltration of neighboring structures on all images. The imaging results were thought to be consistent with an organized subacute thrombus. Repeat imaging 3 months later showed evidence of further liquefaction with no increase in size.

 

View larger version (132K): [in a new window]   Figure 12d.  Right atrial thrombus in a 68-year-old man with dyspnea and atrial fibrillation. At transthoracic echocardiography, there was apparent thickening of the right ventricular free wall. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (857/26) shows a predominantly hyperintense mass (arrows) in the right atrium (RA) with an area of reduced signal intensity and a central area of signal void. AO = aorta, LA = left atrium, RVOT = right ventricular outflow tract. (b) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,500/80) shows that the mass has a more heterogeneous appearance with similar areas of reduced signal intensity and signal void. (c) Axial ECG-gated breath-hold T1-weighted spectral presaturation with IR image (857/26) shows that the mass has almost uniform high signal intensity. (d) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (857/26) shows homogeneous enhancement of the surface of the thrombus. (e) Axial ECG-gated breath-hold SSFP image (3/1.5, 50° flip angle) shows the thrombus (arrows) as a subtle area of reduced signal intensity compared with that of the adjacent blood. Note the lack of infiltration of neighboring structures on all images. The imaging results were thought to be consistent with an organized subacute thrombus. Repeat imaging 3 months later showed evidence of further liquefaction with no increase in size.

 

View larger version (135K): [in a new window]   Figure 12e.  Right atrial thrombus in a 68-year-old man with dyspnea and atrial fibrillation. At transthoracic echocardiography, there was apparent thickening of the right ventricular free wall. (a) Axial ECG-gated breath-hold T1-weighted double IR fast SE image (857/26) shows a predominantly hyperintense mass (arrows) in the right atrium (RA) with an area of reduced signal intensity and a central area of signal void. AO = aorta, LA = left atrium, RVOT = right ventricular outflow tract. (b) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,500/80) shows that the mass has a more heterogeneous appearance with similar areas of reduced signal intensity and signal void. (c) Axial ECG-gated breath-hold T1-weighted spectral presaturation with IR image (857/26) shows that the mass has almost uniform high signal intensity. (d) Axial gadolinium-enhanced ECG-gated breath-hold T1-weighted double IR fast SE image (857/26) shows homogeneous enhancement of the surface of the thrombus. (e) Axial ECG-gated breath-hold SSFP image (3/1.5, 50° flip angle) shows the thrombus (arrows) as a subtle area of reduced signal intensity compared with that of the adjacent blood. Note the lack of infiltration of neighboring structures on all images. The imaging results were thought to be consistent with an organized subacute thrombus. Repeat imaging 3 months later showed evidence of further liquefaction with no increase in size.

 

View larger version (143K): [in a new window]   Figure 13a.  Pericardial cyst in a 70-year-old woman in whom a mass was noted at chest radiography. (a, b) Axial (a) and coronal (b) ECG-gated breath-hold T1-weighted double IR fast SE images (1,600/38) show a mass arising from the right cardiophrenic angle (arrow). The mass is isointense relative to the myocardium and slightly hypo-intense relative to the adjacent liver. RA = right atrium, LV = left ventricle. (c) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,600/120) shows that the mass is uniformly hyperintense, a finding consistent with simple fluid.

 

View larger version (141K): [in a new window]   Figure 13b.  Pericardial cyst in a 70-year-old woman in whom a mass was noted at chest radiography. (a, b) Axial (a) and coronal (b) ECG-gated breath-hold T1-weighted double IR fast SE images (1,600/38) show a mass arising from the right cardiophrenic angle (arrow). The mass is isointense relative to the myocardium and slightly hypo-intense relative to the adjacent liver. RA = right atrium, LV = left ventricle. (c) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,600/120) shows that the mass is uniformly hyperintense, a finding consistent with simple fluid.

 

View larger version (141K): [in a new window]   Figure 13c.  Pericardial cyst in a 70-year-old woman in whom a mass was noted at chest radiography. (a, b) Axial (a) and coronal (b) ECG-gated breath-hold T1-weighted double IR fast SE images (1,600/38) show a mass arising from the right cardiophrenic angle (arrow). The mass is isointense relative to the myocardium and slightly hypo-intense relative to the adjacent liver. RA = right atrium, LV = left ventricle. (c) Axial ECG-gated breath-hold T2-weighted double IR fast SE image (1,600/120) shows that the mass is uniformly hyperintense, a finding consistent with simple fluid.

 

View larger version (134K): [in a new window]   Figure 14a.  Bronchogenic cyst in a 67-year-old man with recurrent episodes of anterior chest pain. (a) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar image (857/25) shows a large hyper-intense mass with areas of low and intermediate signal intensity at the level of the carina (arrows). (b, c) Axial ECG-gated breath-hold T2-weighted double IR fast SE (2,371/120) (b) and spectral pre-saturation with IR (c) images show a mixture of high-, intermediate-, and low-signal-intensity areas, an appearance suggestive of hemorrhage of varying ages. The patient previously underwent resection of an esophageal carcinoma with gastric pull-through surgery (* in c). Arrow in b = signal void from met-hemoglobin.

 

View larger version (127K): [in a new window]   Figure 14b.  Bronchogenic cyst in a 67-year-old man with recurrent episodes of anterior chest pain. (a) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar image (857/25) shows a large hyper-intense mass with areas of low and intermediate signal intensity at the level of the carina (arrows). (b, c) Axial ECG-gated breath-hold T2-weighted double IR fast SE (2,371/120) (b) and spectral pre-saturation with IR (c) images show a mixture of high-, intermediate-, and low-signal-intensity areas, an appearance suggestive of hemorrhage of varying ages. The patient previously underwent resection of an esophageal carcinoma with gastric pull-through surgery (* in c). Arrow in b = signal void from met-hemoglobin.

 

View larger version (136K): [in a new window]   Figure 14c.  Bronchogenic cyst in a 67-year-old man with recurrent episodes of anterior chest pain. (a) Axial ECG-gated non–breath-hold T1-weighted SE echo-planar image (857/25) shows a large hyper-intense mass with areas of low and intermediate signal intensity at the level of the carina (arrows). (b, c) Axial ECG-gated breath-hold T2-weighted double IR fast SE (2,371/120) (b) and spectral pre-saturation with IR (c) images show a mixture of high-, intermediate-, and low-signal-intensity areas, an appearance suggestive of hemorrhage of varying ages. The patient previously underwent resection of an esophageal carcinoma with gastric pull-through surgery (* in c). Arrow in b = signal void from met-hemoglobin.

 

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