Diagnostic Performance Of Contrast-Enhanced Echocardiography In Differentiating Cardiac Masses: A Systematic Review And Meta-analysis

Background  Conventional echocardiography often struggles to differentiate intracardiac masses, particularly in patients with poor acoustic windows. Contrast-enhanced Echocardiography (CEE) overcomes this limitation by visualizing perfusion patterns — distinguishing avascular thrombi from vascularized tumors. We aimed to synthesize existing evidence to evaluate the diagnostic accuracy of CEE.

Objectives  To evaluate the diagnostic accuracy of CEE for differentiating cardiac masses in adults, using histopathology as reference and reporting AUC, sensitivity, specificity, PPV, and NPV.

Methods  Systematic searches of PubMed, Web of Science, Cochrane Library, and EMBASE were performed on August 10, 2025. Studies meeting PICOTT criteria were included; extracted data included sensitivity, specificity, AUC, and 2×2 tables. Pooled estimates were obtained using standard bivariate and SROC models for diagnostic meta-analysis. Statistical significance set at P < 0.05.

Results  Five prospective cohort studies (total n = 381 patients) were included. For tumor vs non-tumor, pooled sensitivity = 100% and specificity = 100% (95% CI 99.5–100%; I² = 0%; heterogeneity P = 0.985), diagnostic odds ratio (DOR) = 3,890.65, AUC = 0.989. For malignant vs benign tumors, pooled sensitivity = 94.3% (95% CI 88.5–97.3%; I² = 0%; P = 0.681), specificity = 96.1% (95% CI 91.5–98.2%; I² = 0%; P = 0.970), DOR = 341.71, SROC AUC = 0.976.

Conclusions  CEE showed very high diagnostic accuracy in the available prospective series. However, the small number of studies and limited sample sizes warrant cautious interpretation; larger prospective multicenter studies with standardized CEE protocols are needed to confirm these results.

Keywords:
Echocardiography; Contrast Media; Cardiac Neoplasms; Systematic Review; Meta-Analysis

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Diagnostic Performance Of Contrast-Enhanced Echocardiography In Differentiating Cardiac Masses: A Systematic Review And Meta-analysis