Cardiovascular imaging in cardio-oncology

Abstract

Cancer therapy may lead to cardiovascular complications and can promote each aspect of cardiac disease manifestation, such as vascular disease including coronary heart disease, myocardial diseases including heart failure, structural heart diseases including valvular heart diseases, and rhythm disorders. All potential complications of cancer therapy onto the cardiovascular system require imaging for diagnostic workup as well as monitoring of therapy. Transthoracic echocardiography (TTE) is the most frequently used tool for assessment of cardiac function during or after cancer therapy in daily clinical routine. With modern techniques like strain analysis, echocardiography allows to detect a variety of cardiac diseases as caused by cancer therapy even at subclinical stages. For further workup, specific imaging techniques including nuclear imaging are needed in a multimodality imaging approach to in detail characterize the underlying pathophysiology and to improve the management of the patients. Therefore, the field of imaging in cardio-oncology is rapidly growing. This review article will give an overview about existing literature regarding the role of imaging in the diagnostic evaluation and management of therapy in patient with prior or ongoing cancer therapy.

Keywords: Cardiovascular imaging; cardio-oncology; computed tomography (CT); echocardiography; magnetic resonance imaging (MRI); multimodality imaging; nuclear cardiac imaging.

Figure 1

Echocardiographic assessment of a 63 years old female patients following anthracycline based therapy for breast cancer. While left ventricular ejection fraction was normal (3D-LVEF: 61%), myocardial strain analysis depicted reduced global longitudinal deformation (LV-GLS: −14.5%) as early sign of chemotherapy induced left ventricular dysfunction. LVEF, left ventricular ejection fraction; GLS, global longitudinal strain; AIS, apical inferoseptal; AAL, apical anterolateral; MIS, mid inferoseptal; MAL, mid anterolateral; BIS, basal inferoseptal; BAL, basal anterolateral.

Figure 2

Planning CT of a patient with esophageal cancer who had to undergo radiation (A: planning CT with isocontours of radiation doses). Myocardial perfusion images demonstrate ischemia of the inferior wall (B: white arrows), that was included in the 4,000–5,000 cGy isocontour. (This research was originally published in JNM. Gayed IW, Liu HH, Yusuf SW, Komaki R, Wei X, Wang X, Chang JY, Swafford J, Broemeling L and Liao Z, J Nucl Med. 2006;47:756-62. ©SNMMI).