Diagnostic Accuracy of an Integrated Multimodality Imaging Approach in Patients With Cardiac Masses

IF 19 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2026-08-01 Epub Date: 2026-05-22 DOI:10.1016/j.jcmg.2026.03.014

Francesco Angeli MD, PhD, Matteo Armillotta MD, Alberto Foà MD, PhD, Damiano Fedele MD, Vincenzo Russo MD, Rachele Bonfiglioli MD, Chiara Baldovini MD, Cristina Mosconi MD, Pasquale Paolisso MD, PhD, Sara Amicone MD, Lisa Canton MD, Marta Belmonte MD, Gianluca Folesani MD, Giacomo Murana MD, Sofia Martin-Suarez MD, Luciano Potena MD, PhD, Stefano Fanti MD, Davide Pacini MD, Luigi Lovato MD, Luca Bergamaschi MD, Carmine Pizzi MD

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引用次数: 0

Abstract

Background

Multimodality imaging plays a central role in the evaluation of cardiac masses (CMs), yet the comparative performance of integrated imaging strategies including cardiac magnetic resonance (CMR), cardiac computed tomography (CCT), and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) remains incompletely defined.

Objectives

This study sought to compare the diagnostic accuracy of multiparametric scores derived from echocardiography, CMR, CCT, and ¹⁸F-FDG PET, individually and in combination, for identifying malignant CMs using histology as the reference standard.

Methods

In this prospective study, patients with suspected CMs underwent echocardiography, CCT, CMR, and ¹⁸F-FDG PET within 2 months of first medical contact. Final diagnosis was established by histology or radiological resolution after anticoagulation therapy for thrombi. Diagnostic performance was assessed using receiver-operating characteristic curves, and the areas under the curve (AUCs) were compared with the DeLong test, applying Bonferroni correction for multiple comparisons. CART (Classification And Regression Tree) analysis assessed the incremental value of PET following CMR or CCT.

Results

Among 142 patients, 54% had malignant CMs. Echocardiography showed the lowest diagnostic accuracy (AUC: 0.77). CMR demonstrated the highest standalone performance (AUC: 0.94), outperforming CCT and ¹⁸F-FDG PET (both AUCs: 0.85). The combination of CMR and ¹⁸F-FDG PET was associated with high diagnostic accuracy (AUC: 0.97; positive predictive value 95.1%; negative predictive value 100%), whereas CCT combined with ¹⁸F-FDG PET achieved an AUC of 0.92. The addition of PET after CMR or CCT was associated with improved diagnostic classification in selected cases, as supported by CART analysis.

Conclusions

CMR provides the highest standalone accuracy for malignancy detection. In inconclusive cases, adding ¹⁸F-FDG PET further improves diagnostic performance, while CCT combined with ¹⁸F-FDG PET represents a reliable alternative.

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综合多模态成像方法对心脏肿块的诊断准确性。

背景：多模态成像在心脏肿块（CMs）的评估中起着核心作用，但包括心脏磁共振（CMR）、心脏计算机断层扫描（CCT）和18f -氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET）在内的综合成像策略的比较性能仍然不完全确定。目的：本研究旨在比较超声心动图、CMR、CCT和18F-FDG PET的多参数评分的诊断准确性，以组织学为参考标准，单独或联合诊断恶性CMs。方法：在这项前瞻性研究中，疑似CMs患者在首次医疗接触后2个月内接受超声心动图、CCT、CMR和18F-FDG PET检查。最终诊断是通过抗凝治疗血栓后的组织学或放射学分辨率来确定的。使用受试者工作特征曲线评估诊断性能，并将曲线下面积（auc）与DeLong检验进行比较，采用Bonferroni校正进行多重比较。CART（分类与回归树）分析评估CMR或CCT后PET的增量价值。结果：142例患者中，恶性CMs占54%。超声心动图诊断准确率最低（AUC: 0.77）。CMR表现出最高的独立性能（AUC: 0.94），优于CCT和18F-FDG PET （AUC均为0.85）。CMR联合18F-FDG PET具有较高的诊断准确率（AUC: 0.97，阳性预测值95.1%，阴性预测值100%），而CCT联合18F-FDG PET的AUC为0.92。在特定病例中，在CMR或CCT后添加PET与改进的诊断分类相关，CART分析也支持这一点。结论：CMR为恶性肿瘤检测提供了最高的独立准确率。在不确定的病例中，添加18F-FDG PET进一步提高诊断性能，而CCT联合18F-FDG PET是一种可靠的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.