Is It a Cardiac Tumor or a Thrombus: An Everlasting Dilemma solved by Radiomics Analysis

Deciphering cardiac tumor from cardiac thrombus is a diagnostic conundrum and an arduous clinical journey despite their low prevalence ( 1 Butany J Nair V Naseemuddin A Nair GM Catton C Yau T Cardiac tumours: diagnosis and management. Lancet Oncol. 2005; 6: 219-228 Abstract Full Text Full Text PDF PubMed Scopus (496) Google Scholar , 2 Pazos-Lopez P Pozo E Siqueira ME et al. Value of CMR for the differential diagnosis of cardiac masses. JACC Cardiovasc Imaging. 2014; 7: 896-905 Crossref PubMed Scopus (92) Google Scholar , 3 McAllister HA Hall RJ Cooley DA Tumors of the heart and pericardium. Curr Probl Cardiol. 1999; 24: 57-116 Crossref PubMed Google Scholar ). The question “Is it a cardiac tumor or a thrombus” is a ubiquitous clinical dilemma preferentially solved by state-of-the-art cardiac imaging. Initially detected on echocardiography, cardiac masses are further evaluated by cross-sectional imaging such as cardiac computed tomography and cardiac magnetic resonance (CMR), the latter demonstrating superiority in tissue characterization ( 2 Pazos-Lopez P Pozo E Siqueira ME et al. Value of CMR for the differential diagnosis of cardiac masses. JACC Cardiovasc Imaging. 2014; 7: 896-905 Crossref PubMed Scopus (92) Google Scholar , 4 Luna A Ribes R Caro P Vida J Erasmus JJ Evaluation of cardiac tumors with magnetic resonance imaging. Eur Radiol. 2005; 15: 1446-1455 Crossref PubMed Scopus (99) Google Scholar ). While cardiac thrombus is more prevalent than cardiac tumor, accurate diagnosis and differentiation between cardiac thrombus and tumor is critical in tailoring appropriate management strategies for these patients. CMR imaging, in particular, post gadolinium imaging, allows for tissue characterization based on the presence and pattern of early and late gadolinium enhancement exhibited by the mass in addition to its longitudinal behavior ( 2 Pazos-Lopez P Pozo E Siqueira ME et al. Value of CMR for the differential diagnosis of cardiac masses. JACC Cardiovasc Imaging. 2014; 7: 896-905 Crossref PubMed Scopus (92) Google Scholar , 4 Luna A Ribes R Caro P Vida J Erasmus JJ Evaluation of cardiac tumors with magnetic resonance imaging. Eur Radiol. 2005; 15: 1446-1455 Crossref PubMed Scopus (99) Google Scholar ). This chain of information combines the imaging endpoints and clinical information allowing for a more accurate diagnosis. Cardiac imaging is used to identify the presence of cardiac mass, while the presence and pattern of gadolinium enhancement are used to distinguish between cardiac tumor and cardiac thrombus ( 5 Hong YJ Hur J Han K et al. Quantitative analysis of a whole cardiac mass using dual-energy computed tomography: comparison with conventional computed tomography and magnetic resonance imaging. Sci Rep. 2018; 8: 15334 Crossref PubMed Scopus (9) Google Scholar , 6 Weinsaft JW Kim HW Shah DJ et al. Detection of left ventricular thrombus by delayed-enhancement cardiovascular magnetic resonance prevalence and markers in patients with systolic dysfunction. J Am Coll Cardiol. 2008; 52: 148-157 Crossref PubMed Scopus (194) Google Scholar ).