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Background  Late gadolinium enhancement (LGE-) cardiovascular magnetic resonance (CMR) is well-validated for cardiac mass (C MASS ) tissue characterization to differentiate neoplasm (C NEO ) from thrombus (C THR ): Prognostic implications of C MASS  subtypes among systemic cancer patients are unknown.    Methods  C MASS  + patients and controls (C MASS  -) matched for cancer diagnosis and stage underwent a standardized CMR protocol, including LGE-CMR (IR-GRE) for tissue characterization and balanced steady state free precession cine-CMR (SSFP) for cardiac structure/function. C MASS  subtypes (C NEO , C THR ) were respectively defined by presence or absence of enhancement on LGE-CMR; lesions were quantified for tissue properties (contrast-to-noise ratio (CNR); signal-to-noise ratio (SNR) and size. Clinical follow-up was performed to evaluate prognosis in relation to C MASS  etiology.    Results  The study population comprised 126 patients with systemic neoplasms referred for CMR, of whom 50% ( n  = 63) had C MASS  + (C NEO  = 32%, C THR  = 18%). Cancer etiology differed between C NEO  (sarcoma = 20%, lung = 18%) and C THR  (lymphoma = 30%, GI = 26%); cardiac function (left ventricular ejection fraction: 63 ± 9 vs. 62 ± 10%;  p  = 0.51∣ right ventricular ejection fraction: 53 ± 9 vs. 54 ± 8%;  p  = 0.47) and geometric indices were similar (all p = NS). LGE-CMR tissue properties assessed by CNR (13.1 ± 13.0 vs. 1.6 ± 1.0;  p  < 0.001) and SNR (29.7 ± 20.4 vs. 15.0 ± 11.4,  p  = 0.003) were higher for C NEO , consistent with visually-assigned diagnostic categories. C THR  were more likely to localize to the right atrium (78% vs. 25%, p < 0.001); nearly all (17/18) were associated with central catheters. Lesion size (17.3 ± 23.8 vs. 2.0 ± 1.5 cm 2 ; p < 0.001) was greater with C NEO  vs. C THR , as was systemic disease burden (cancer-involved organs: 3.6 ± 2.0 vs. 2.3 ± 2.1;  p  = 0.02). Mortality during a median follow-up of 2.5 years was markedly higher among patients with C NEO  compared to those with C THR  (HR = 3.13 [CI 1.54–6.39],  p  = 0.002); prognosis was similar when patients were stratified by lesion size assessed via area (HR = 0.99 per cm 2  [CI 0.98–1.01],  p  = 0.40) or maximal diameter (HR = 0.98 per cm [CI 0.91–1.06],  p  = 0.61). C THR  conferred similar mortality risk compared to cancer-matched controls without cardiac involvement ( p  = 0.64) whereas mortality associated with C NEO  was slightly higher albeit non-significant ( p  = 0.12).    Conclusions  Among a broad cancer cohort with cardiac masses, C NEO  defined by LGE-CMR tissue characterization conferred markedly poorer prognosis than C THR , whereas anatomic assessment via cine-CMR did not stratify mortality risk. Both C NEO  and C THR  are associated with similar prognosis compared to C MASS  - controls matched for cancer type and disease extent.

journal of cardiovascular magnetic resonance

Prognostic utility of differential tissue characterization of cardiac neoplasm and thrombus via late gadolinium enhancement cardiovascular magnetic resonance among patients with advanced systemic cancer