多模态影像整合策略对心脏肿块的诊断准确性
本前瞻性研究纳入142例疑似心脏肿块患者，比较超声心动图、心脏CT、心脏MR和18F-FDG PET单独及联合诊断恶性肿块的准确性，以组织学或抗凝后影像消退为参考标准。心脏MR单独诊断AUC最高（0.94），心脏MR联合PET的AUC达0.97（阳性预测值95.1%，阴性预测值100%），心脏CT联合PET的AUC为0.92。结论认为心脏MR单独准确性最高，联合PET可进一步改善不确定病例的诊断性能。
要点
- 心脏MR单独诊断恶性心脏肿块准确性最高（AUC 0.94）。
- 心脏MR联合18F-FDG PET的AUC达0.97，阴性预测值100%。
- 心脏CT联合PET可作为可靠替代方案（AUC 0.92）。
核心结论
- 心脏MR对恶性心脏肿块诊断准确性最高，联合18F-FDG PET可进一步提升诊断性能。
研究设计与样本
- 前瞻性研究纳入142例疑似心脏肿块患者，均行超声心动图、心脏CT、心脏MR和18F-FDG PET检查。
- 参考标准为组织学诊断或抗凝治疗后影像学消退（针对血栓）。
- 诊断性能采用ROC曲线评估，AUC比较使用DeLong检验并应用Bonferroni校正。
诊断标准与关键数值
- 超声心动图诊断恶性心脏肿块的AUC为0.77。
- 心脏MR单独诊断AUC为0.94，优于心脏CT和18F-FDG PET（两者AUC均为0.85）。
- 心脏MR联合18F-FDG PET的AUC为0.97，阳性预测值95.1%，阴性预测值100%。
- 心脏CT联合18F-FDG PET的AUC为0.92。
临床应用与阅片要点
- 疑似心脏肿块首选心脏MR评估恶性风险。
- 心脏MR或CT结论不确定时，加做18F-FDG PET可改善诊断分类。
- 无法行心脏MR时，心脏CT联合18F-FDG PET可作为可靠替代方案。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
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.
引用
- Angeli F, Armillotta M, Foà A, et al. Diagnostic Accuracy of an Integrated Multimodality Imaging Approach in Patients With Cardiac Masses. JACC Cardiovasc Imaging. 2026. PMID: 42171548. doi:10.1016/j.jcmg.2026.03.014
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。