RESUMO
BACKGROUND: After diagnosis of a cardiac mass, clinicians must weigh the benefits and risks of ascertaining a tissue diagnosis. Limited data are available on the accuracy of previously developed noninvasive pediatric cardiac magnetic resonance (CMR)-based diagnostic criteria. OBJECTIVES: The goals of this study were to: 1) evaluate the CMR characteristics of pediatric cardiac masses from a large international cohort; 2) test the accuracy of previously developed CMR-based diagnostic criteria; and 3) expand diagnostic criteria using new information. METHODS: CMR studies (children 0-18 years of age) with confirmatory histological and/or genetic diagnosis were analyzed by 2 reviewers, without knowledge of prior diagnosis. Diagnostic accuracy was graded as: 1) single correct diagnosis; 2) correct diagnosis among a differential; or 3) incorrect diagnosis. RESULTS: Of 213 cases, 174 (82%) had diagnoses that were represented in the previously published diagnostic criteria. In 70% of 174 cases, both reviewers achieved a single correct diagnosis (94% of fibromas, 71% of rhabdomyomas, and 50% of myxomas). When ≤2 differential diagnoses were included, both reviewers reached a correct diagnosis in 86% of cases. Of 29 malignant tumors, both reviewers indicated malignancy as a single diagnosis in 52% of cases. Including ≤2 differential diagnoses, both reviewers indicated malignancy in 83% of cases. Of 6 CMR sequences examined, acquisition of first-pass perfusion and late gadolinium enhancement were independently associated with a higher likelihood of a single correct diagnosis. CONCLUSIONS: CMR of cardiac masses in children leads to an accurate diagnosis in most cases. A comprehensive imaging protocol is associated with higher diagnostic accuracy.
Assuntos
Meios de Contraste , Neoplasias Cardíacas , Criança , Gadolínio , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Imageamento por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
El síndrome de Loeys-Dietz es una enfermedad genética autosómica dominante caracterizada por aneurismas aórticos, tortuosidad arterial generalizada, hipertelorismo y úvula bifida o paladar hendido. La complicación cardiovascular más grave es la disección aórtica. Se presentan cuatro casos familiares de este síndrome en tres generaciones, todos con dilatación aórtica grave, y se describen sus aspectos diagnósticos, indicación y tratamiento quirúrgico, como así también pautas de seguimiento.
Loeys-Dietz Syndrome is an autosomal dominant disease with aortic aneurysms, arterial tortuosity with hypertelorism and bifid uvula. We describe four familial cases within three generations. The diagnosis, surgical management and followup will be addressed.
Assuntos
Humanos , Masculino , Adolescente , Síndrome de Loeys-Dietz/genética , Síndrome de Loeys-Dietz/cirurgia , Síndrome de Loeys-Dietz/diagnósticoRESUMO
Loeys-Dietz Syndrome is an autosomal dominant disease with aortic aneurysms, arterial tortuosity with hypertelorism and bifid uvula. We describe four familial cases within three generations. The diagnosis, surgical management and followup will be addressed.
El síndrome de Loeys-Dietz es una enfermedad genética autosómica dominante caracterizada por aneurismas aórticos, tortuosidad arterial generalizada, hipertelorismo y úvula bífida o paladar hendido. La complicación cardiovascular más grave es la disección aórtica. Se presentan cuatro casos familiares de este síndrome en tres generaciones, todos con dilatación aórtica grave, y se describen sus aspectos diagnósticos, indicación y tratamiento quirúrgico, como así también pautas de seguimiento.
