The Role of Cardiovascular Magnetic Resonance in the Management of Patients with Cancer
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Purpose of review
This article reviews the utility of cardiovascular magnetic resonance imaging (CMR) to detect abnormalities of the cardiovascular system that may result from cancer or its treatment.
With CMR, one may assess cardiac anatomy, function, myocardial perfusion, tissue composition, and blood flow. For those with cancer, these capabilities allow one to differentiate myocardial masses that may relate to the presence of cancer and evaluate diseases of the pericardium. These features facilitate measurement of left ventricular (LV) volumes, ejection fraction, mass, strain, T1 and T2 relaxation properties, and the extracellular volume fraction all of which may be useful for detecting subclinical cardiovascular injury that results from the receipt of potentially cardiotoxic cancer treatment.
CMR can provide an effective and efficient means to identify clinical abnormalities resulting from the diagnosis of cancer or subclinical cardiac injury that may be related to receipt of the therapy for cancer.
KeywordsCardiovascular magnetic resonance Imaging Cancer
The author appreciates the editorial assistance of Anna E. Hundley in preparation of the manuscript.
Research supported in part by the National Institute of Health grants (R01CA199167, R01CA167821, R01HL118740).
Compliance with Ethical Standards
Conflict of Interest
W. George Hundley reports research supported in part by the National Institute of Health grants (R01CA199167, R01CA167821, R01HL118740).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
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- 1.• Vasu S, Hundley WG. Understanding cardiovascular injury after treatment for cancer: an overview of current uses and future directions of cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2013;15:66–84. This manuscript provides a nice discussion of the use of cardiovascular magnetic resonance for assessing individuals with cancer.CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Staab W, Bergau L, Schuster A, Hinojar R, Dorenkamp M, Obenauer S, et al. Detection of intracardiac masses in patients with coronary artery disease using cardiac magnetic resonance imaging: a comparison with transthoracic echocardiography. Int J Cardiovasc Imaging. 2014;30(3):647–57.CrossRefPubMedGoogle Scholar
- 8.Chan AT, Plodkowski AJ, Pun SC, Lakhman Y, Halpenny DF, Kim J, et al. Prognostic utility of differential tissue characterization of cardiac neoplasm and thrombus via late gadolinium enhancement cardiovascular magnetic resonance among patients with advanced systemic cancer. J Cardiovasc Magn Reson. 2017;19(1):76–87.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Wang ZJ, Reddy GP, Gotway MB, Yeh BM, Hetts SW, Higgins CB. CT and MR imaging of pericardial disease. Radiographics. 2003;23 Spec No:S167-80.Google Scholar
- 20.•• Meléndez GC, Sukpraphrute B, D'agostino RB, et al. Frequency of left ventricular end-diastolic volume-mediated declines in ejection fraction in patients receiving potentially cardiotoxic cancer treatment. Am J Cardiol. 2017;119(10):1637–42. Nearly 20% of individuals that develop declines in left ventricular ejection fraction receiving anthracycline-based chemotherapy do so due to an isolated decline in left ventricular end-diastolic volume as opposed to an increase in left ventricular end-systolic volume. These data emphasize the importance of interpreting declines in left ventricular ejection fraction in patients receiving potentially cardiotoxic chemotherapy to consider simultaneous changes in left ventricular volumes. A decline in left ventricular end-diastolic volume could suggest intravascular volume depletion as opposed to cancer therapeutic-associated cardiotoxic effect on the myocardium which would lead to an increase in left ventricular end-systolic volume.CrossRefPubMedGoogle Scholar
- 21.Barthur A, Brezden-masley C, Connelly KA, et al. Longitudinal assessment of right ventricular structure and function by cardiovascular magnetic resonance in breast cancer patients treated with trastuzumab: a prospective observational study. J Cardiovasc Magn Reson. 2017;19(1):44.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Nakano S, Takahashi M, Kimura F, Senoo T, Saeki T, Ueda S, et al. Cardiac magnetic resonance imaging-based myocardial strain study for evaluation of cardiotoxicity in breast cancer patients treated with trastuzumab: a pilot study to evaluate the feasibility of the method. Cardiol J. 2016;23(3):270–80.CrossRefPubMedGoogle Scholar
- 23.•• Jolly MP, Jordan JH, Meléndez GC, Mcneal GR, D'Agostino RB, Hundley WG. Automated assessments of circumferential strain from cine CMR correlate with LVEF declines in cancer patients early after receipt of cardio-toxic chemotherapy. J Cardiovasc Magn Reson. 2017;19(1):59–62. This manuscript describes a new technique using the automated analysis of cine white blood left ventricular imaging methods to calculate mean, mid-wall circumferential strain that is associated with declines in left ventricular ejection fraction in patients with cancer receiving potentially cardiotoxic chemotherapy.CrossRefPubMedPubMedCentralGoogle Scholar
- 26.• Jordan JH, Sukpraphrute B, Meléndez GC, Jolly MP, D'agostino RB, Hundley WG. Early myocardial strain changes during potentially cardiotoxic chemotherapy may occur as a result of reductions in left ventricular end-diastolic volume: the need to interpret left ventricular strain with volumes. Circulation. 2017;135(25):2575–7. Results from a prospective study indicating that left ventricular circumferential strain may deteriorate in patients with cancer due to an isolated reduction in left ventricular end-diastolic volume, thereby emphasizing one must interpret left ventricular strain changes in patients with cancer after considering simultaneously change in left ventricular end-diastolic and end systolic volume.CrossRefPubMedGoogle Scholar
- 29.Jordan JH, D'agostino RB, Hamilton CA, et al. Longitudinal assessment of concurrent changes in left ventricular ejection fraction and left ventricular myocardial tissue characteristics after administration of cardiotoxic chemotherapies using T1-weighted and T2-weighted cardiovascular magnetic resonance. Circ Cardiovasc Imaging. 2014;7(6):872–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Tham EB, Haykowsky MJ, Chow K, Spavor M, Kaneko S, Khoo NS, et al. Diffuse myocardial fibrosis by T1-mapping in children with subclinical anthracycline cardiotoxicity: relationship to exercise capacity, cumulative dose and remodeling. J Cardiovasc Magn Reson. 2013;15:48–59.CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Heck SL, Gulati G, Hoffmann P, et al. Effect of candesartan and metoprolol on myocardial tissue composition during anthracycline treatment: the PRADA trial. Eur Heart J Cardiovasc Imaging. 2017:159–67.Google Scholar
- 36.Bosch X, Rovira M, Sitges M, Domènech A, Ortiz-Pérez JT, de Caralt TM, et al. Enalapril and carvedilol for preventing chemotherapy-induced left ventricular systolic dysfunction in patients with malignant hemopathies: the OVERCOME trial (preventiOn of left Ventricular dysfunction with Enalapril and caRvedilol in patients submitted to intensive ChemOtherapy for the treatment of Malignant hEmopathies). J Am Coll Cardiol. 2013;61(23):2355–62.CrossRefPubMedGoogle Scholar
- 37.Pituskin E, Mackey JR, Koshman S, et al. Multidisciplinary Approach to Novel Therapies in Cardio-Oncology Research (MANTICORE 101-Breast): a randomized trial for the prevention of trastuzumab-associated cardiotoxicity. J Clin Oncol. 2016;JCO2016687830.Google Scholar
- 38.• Ingkanisorn WP, Paterson DI, Calvo KR, Rosing D, Schwartzentruber D, Fuisz A, et al. Cardiac magnetic resonance appearance of myocarditis caused by high dose IL-2: similarities to community-acquired myocarditis. J Cardiovasc Magn Reson. 2006;8(2):353–60. This article demonstrates that the features of myocarditis associated with immunotherapy bears similarity to features of other community acquired forms of myocarditis that have been previously described using CMR imaging.CrossRefPubMedGoogle Scholar
- 42.Pozo E, Castellano JM, Kanwar A, et al. Myocardial amyloid quantification with look-locker magnetic resonance sequence in cardiac amyloidosis. Diagnostic accuracy in clinical practice and histological validation. J Card Fail. 2017;08:445–53.Google Scholar