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Abstract：
BACKGROUND: Cardiac masses can encompass a variety of conditions, such as tumors, thrombi, vegetations, calcific lesions, and other rare diseases. Treatment and management of these types of cardiac masses differ considerably. Thus, accurately distinguishing among thrombi, benign tumors, and malignant tumors in the heart is of great importance. Contrast echocardiography (CE) has emerged as a promising technology. Although published guidelines suggest that CE can enhance image quality and assist in differentiating between benign and malignant lesions, most studies on CE diagnosis of cardiac masses are limited to case reports or retrospective/small-sample-sized prospective cohorts. This study aims to evaluate the diagnostic accuracy of CE in patients with suspected cardiac masses and address the insufficient evidence for differential diagnosis using CE.
METHODS: Between April 2018 and July 2022, a prospective multicenter study was conducted, which included 145 consecutive patients suspected to have cardiac masses based on transthoracic echocardiography. All patients underwent CE examinations. The echocardiographic diagnosis relied on qualitative factors such as echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility as well as quantitative factors such as the area of the masses and the peak intensity ratio of the masses to adjacent myocardium (A1/A2).
RESULTS: The final confirmed diagnoses were as follows: 2 patients had no cardiac mass, 4 patients had pseudomass, 43 patients had thrombus, 66 patients had benign tumors, and 30 patients had malignant tumors. The receiver operating characteristic (ROC) analysis indicated that an optimal A1/A2 cutoff value of 0.499 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.977, 97.9%, 90.7%, 95.9%, and 95.1%, respectively. The optimal A1/A2 cutoff value of 1.583 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.950, 93.3%, 93.9%, 87.5%, and 96.9%, respectively.
CONCLUSIONS: Combined with qualitative and quantitative analyses, CE has the potential to accurately differentiate among different types of cardiac masses.
METHODS: Between April 2018 and July 2022, a prospective multicenter study was conducted, which included 145 consecutive patients suspected to have cardiac masses based on transthoracic echocardiography. All patients underwent CE examinations. The echocardiographic diagnosis relied on qualitative factors such as echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility as well as quantitative factors such as the area of the masses and the peak intensity ratio of the masses to adjacent myocardium (A1/A2).
RESULTS: The final confirmed diagnoses were as follows: 2 patients had no cardiac mass, 4 patients had pseudomass, 43 patients had thrombus, 66 patients had benign tumors, and 30 patients had malignant tumors. The receiver operating characteristic (ROC) analysis indicated that an optimal A1/A2 cutoff value of 0.499 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.977, 97.9%, 90.7%, 95.9%, and 95.1%, respectively. The optimal A1/A2 cutoff value of 1.583 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.950, 93.3%, 93.9%, 87.5%, and 96.9%, respectively.
CONCLUSIONS: Combined with qualitative and quantitative analyses, CE has the potential to accurately differentiate among different types of cardiac masses.
摘要：
背景：心脏肿块可以包含多种情况，如肿瘤，血栓,植被,钙化性病变,和其他罕见疾病。这些类型的心脏肿块的治疗和管理差异很大。因此，准确区分血栓，良性肿瘤,心脏的恶性肿瘤非常重要。对比超声心动图（CE）已成为一种有前途的技术。尽管已发布的指南表明CE可以提高图像质量并有助于区分良性和恶性病变，大多数关于心脏肿块CE诊断的研究仅限于病例报告或回顾性/小样本前瞻性队列.这项研究旨在评估CE在可疑心脏肿块患者中的诊断准确性，并解决使用CE进行鉴别诊断的证据不足的问题。
方法：在2018年4月至2022年7月之间，进行了一项前瞻性多中心研究，其中包括根据经胸超声心动图连续怀疑有心脏肿块的145例患者。所有患者均接受CE检查。超声心动图诊断依赖于定性因素，如回声，边界,基底的形态，质量灌注,心包积液,和运动性以及定量因素，例如肿块的面积和肿块与相邻心肌的峰值强度比（A1/A2）。
结果：最终确诊为：2例患者无心脏质量，4个病人有假性肿块,43例患者有血栓,66例患者有良性肿瘤，30例患者有恶性肿瘤。接收器工作特性（ROC）分析表明，最佳A1/A2截止值为0.499可区分心脏肿瘤与血栓，AUC,灵敏度,特异性，PPV,净现值为0.977、97.9%，90.7%,95.9%,和95.1％，分别。最佳A1/A2截止值1.583区分心脏肿瘤和血栓，AUC,灵敏度,特异性，PPV,净现值为0.950，93.3%，93.9%,87.5%,96.9%,分别。
结论：结合定性和定量分析，CE具有准确区分不同类型的心脏质量的潜力。
方法：在2018年4月至2022年7月之间，进行了一项前瞻性多中心研究，其中包括根据经胸超声心动图连续怀疑有心脏肿块的145例患者。所有患者均接受CE检查。超声心动图诊断依赖于定性因素，如回声，边界,基底的形态，质量灌注,心包积液,和运动性以及定量因素，例如肿块的面积和肿块与相邻心肌的峰值强度比（A1/A2）。
结果：最终确诊为：2例患者无心脏质量，4个病人有假性肿块,43例患者有血栓,66例患者有良性肿瘤，30例患者有恶性肿瘤。接收器工作特性（ROC）分析表明，最佳A1/A2截止值为0.499可区分心脏肿瘤与血栓，AUC,灵敏度,特异性，PPV,净现值为0.977、97.9%，90.7%,95.9%,和95.1％，分别。最佳A1/A2截止值1.583区分心脏肿瘤和血栓，AUC,灵敏度,特异性，PPV,净现值为0.950，93.3%，93.9%,87.5%,96.9%,分别。
结论：结合定性和定量分析，CE具有准确区分不同类型的心脏质量的潜力。
