Caterina Beatrice Monti1, Moreno Zanardo1, Tommaso Bosetti2, Marco Alì3,4, Elena De Benedictis5, Alberto Luporini6, Francesco Secchi1,4, Francesco Sardanelli1,4. 1. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy. 2. Medicine and Surgery School, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy. 3. Unit of Diagnostic Imaging and Stereotactic Radiosurgery, CDI Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147 Milan, Italy. 4. Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy. 5. Unit of Oncology I, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy. 6. Unit of Oncology II, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
Abstract
BACKGROUND: Cancer treatment with anthracyclines may lead to an increased incidence of cardiac disease due to cardiotoxicity, as they may cause irreversible myocardial fibrosis. So far, the proposed methods for screening patients for cardiotoxicity have led to only limited success, while the analysis of myocardial extracellular volume (mECV) at cardiac magnetic resonance (CMR) has shown promising results, albeit requiring a dedicated exam. Recent studies have found strong correlations between mECV values obtained through computed tomography (CT), and those derived from CMR. Thus, our purpose was to evaluate the feasibility of estimating mECV on thoracic contrast-enhanced CT performed for staging or follow-up in breast cancer patients treated with anthracyclines, and, if feasible, to assess if a rise in mECV is associated with chemotherapy, and persistent over time. METHODS: After ethics committee approval, female patients with breast cancer who had undergone at least 2 staging or follow-up CT examinations at our institution, one before and one shortly after the end of chemotherapy including anthracyclines were retrospectively evaluated. Patients without available haematocrit, with artefacts in CT images, or who had undergone radiation therapy of the left breast were excluded. Follow-up CT examinations at longer time intervals were also analysed, when available. mECV was calculated on scans obtained at 1, and 7 min after contrast injection. RESULTS: Thirty-two female patients (aged 57±13 years) with pre-treatment haematocrit 38%±4%, and ejection fraction 64%±6% were analysed. Pre-treatment mECV was 27.0%±2.9% at 1 min, and 26.4%±3.8% at 7 min, similar to values reported for normal subjects in the literature. Post-treatment mECV (median interval: 89 days after treatment) was 31.1%±4.9%, and 30.0%±5.1%, respectively, values significantly higher than pre-treatment values at all times (P<0.005). mECV at follow-up (median interval: 135 days after post-treatment CT) was 31.0%±4.5%, and 27.7%±3.7%, respectively, without significant differences (P>0.548) when compared to post-treatment values. CONCLUSIONS: mECV values from contrast-enhanced CT scans could play a role in the assessment of myocardial condition in breast cancer patients undergoing anthracycline-based chemotherapy. CT-derived ECV could be an imaging biomarker for the monitoring of therapy-related cardiotoxicity, allowing for potential secondary prevention of cardiac damage, using data derived from an examination that could be already part of patients' clinical workflow. 2020 Quantitative Imaging in Medicine and Surgery. All rights reserved.
BACKGROUND: Cancer treatment with anthracyclines may lead to an increased incidence of cardiac disease due to cardiotoxicity, as they may cause irreversible myocardial fibrosis. So far, the proposed methods for screening patients for cardiotoxicity have led to only limited success, while the analysis of myocardial extracellular volume (mECV) at cardiac magnetic resonance (CMR) has shown promising results, albeit requiring a dedicated exam. Recent studies have found strong correlations between mECV values obtained through computed tomography (CT), and those derived from CMR. Thus, our purpose was to evaluate the feasibility of estimating mECV on thoracic contrast-enhanced CT performed for staging or follow-up in breast cancer patients treated with anthracyclines, and, if feasible, to assess if a rise in mECV is associated with chemotherapy, and persistent over time. METHODS: After ethics committee approval, female patients with breast cancer who had undergone at least 2 staging or follow-up CT examinations at our institution, one before and one shortly after the end of chemotherapy including anthracyclines were retrospectively evaluated. Patients without available haematocrit, with artefacts in CT images, or who had undergone radiation therapy of the left breast were excluded. Follow-up CT examinations at longer time intervals were also analysed, when available. mECV was calculated on scans obtained at 1, and 7 min after contrast injection. RESULTS: Thirty-two female patients (aged 57±13 years) with pre-treatment haematocrit 38%±4%, and ejection fraction 64%±6% were analysed. Pre-treatment mECV was 27.0%±2.9% at 1 min, and 26.4%±3.8% at 7 min, similar to values reported for normal subjects in the literature. Post-treatment mECV (median interval: 89 days after treatment) was 31.1%±4.9%, and 30.0%±5.1%, respectively, values significantly higher than pre-treatment values at all times (P<0.005). mECV at follow-up (median interval: 135 days after post-treatment CT) was 31.0%±4.5%, and 27.7%±3.7%, respectively, without significant differences (P>0.548) when compared to post-treatment values. CONCLUSIONS: mECV values from contrast-enhanced CT scans could play a role in the assessment of myocardial condition in breast cancer patients undergoing anthracycline-based chemotherapy. CT-derived ECV could be an imaging biomarker for the monitoring of therapy-related cardiotoxicity, allowing for potential secondary prevention of cardiac damage, using data derived from an examination that could be already part of patients' clinical workflow. 2020 Quantitative Imaging in Medicine and Surgery. All rights reserved.
Authors: Kalpana M Kanal; Priscilla F Butler; Debapriya Sengupta; Mythreyi Bhargavan-Chatfield; Laura P Coombs; Richard L Morin Journal: Radiology Date: 2017-02-21 Impact factor: 11.105
Authors: Erik B Schelbert; Kayla M Piehler; Karolina M Zareba; James C Moon; Martin Ugander; Daniel R Messroghli; Uma S Valeti; Chung-Chou H Chang; Sanjeev G Shroff; Javier Diez; Christopher A Miller; Matthias Schmitt; Peter Kellman; Javed Butler; Mihai Gheorghiade; Timothy C Wong Journal: J Am Heart Assoc Date: 2015-12-18 Impact factor: 5.501
Authors: Thomas A Treibel; Steve Bandula; Marianna Fontana; Steven K White; Janet A Gilbertson; Anna S Herrey; Julian D Gillmore; Shonit Punwani; Philip N Hawkins; Stuart A Taylor; James C Moon Journal: J Cardiovasc Comput Tomogr Date: 2015-07-10