The Role of Cardiovascular Magnetic Resonance in the Management of Patients with Cancer

  • W. Gregory Hundley
Cardio-oncology (M Fradley, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardio-oncology


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.

Recent findings

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.


Cardiovascular magnetic resonance Imaging Cancer 



The author appreciates the editorial assistance of Anna E. Hundley in preparation of the manuscript.

Grant Support

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

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 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
  2. 2.
    Kongbundansuk S, Hundley WG. Noninvasive imaging of cardiovascular injury related to the treatment of cancer. JACC Cardiovasc Imaging. 2014;7(8):824–38.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Thavendiranathan P, Wintersperger BJ, Flamm SD, Marwick TH. Cardiac MRI in the assessment of cardiac injury and toxicity from cancer chemotherapy: a systematic review. Circ Cardiovasc Imaging. 2013;6(6):1080–91.CrossRefPubMedGoogle Scholar
  4. 4.
    Caspar T, El Ghannudi S, Ohana M, et al. Magnetic resonance evaluation of cardiac thrombi and masses by T1 and T2 mapping: an observational study. Int J Cardiovasc Imaging. 2017;33(4):551–9.CrossRefPubMedGoogle Scholar
  5. 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
  6. 6.
    Fussen S, De Boeck BW, Zellweger MJ, et al. Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours. Eur Heart J. 2011;32(12):1551–60.CrossRefPubMedGoogle Scholar
  7. 7.
    Pazos-lópez P, Pozo E, Siqueira ME, et al. Value of CMR for the differential diagnosis of cardiac masses. JACC Cardiovasc Imaging. 2014;7(9):896–905.CrossRefPubMedGoogle Scholar
  8. 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
  9. 9.
    White CS. MR evaluation of the pericardium and cardiac malignancies. Magn Reson Imaging Clin N Am. 1996;4(2):237–51.PubMedGoogle Scholar
  10. 10.
    Kojima S, Yamada N, Goto Y. Diagnosis of constrictive pericarditis by tagged cine magnetic resonance imaging. N Engl J Med. 1999;341(5):373–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Maisch B, Ristic A, Pankuweit S. Evaluation and management of pericardial effusion in patients with neoplastic disease. Prog Cardiovasc Dis. 2010;53(2):157–63.CrossRefPubMedGoogle Scholar
  12. 12.
    Imazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E, et al. Relation of acute pericardial disease to malignancy. Am J Cardiol. 2005;95(11):1393–4.CrossRefPubMedGoogle Scholar
  13. 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
  14. 14.
    Hundley WG, Bluemke DA, Finn JP, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation. 2010;121(22):2462–508.CrossRefPubMedGoogle Scholar
  15. 15.
    Handke M, Schöchlin A, Schäfer DM, Beyersdorf F, Geibel A. Myxoma of the mitral valve: diagnosis by 2-dimensional and 3-dimensional echocardiography. J Am Soc Echocardiogr. 1999;12(9):1435–8.CrossRefGoogle Scholar
  16. 16.
    Lunning MA, Kutty S, Rome ET, Li L, Padiyath A, Loberiza F, et al. Cardiac magnetic resonance imaging for the assessment of the myocardium after doxorubicin-based chemotherapy. Am J Clin Oncol. 2015;38(4):377–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Ylänen K, Poutanen T, Savikurki-heikkilä P, Rinta-kiikka I, Eerola A, Vettenranta K. Cardiac magnetic resonance imaging in the evaluation of the late effects of anthracyclines among long-term survivors of childhood cancer. J Am Coll Cardiol. 2013;61(14):1539–47.CrossRefPubMedGoogle Scholar
  18. 18.
    Drafts BC, Twomley KM, D'agostino R, et al. Low to moderate dose anthracycline-based chemotherapy is associated with early noninvasive imaging evidence of subclinical cardiovascular disease. JACC Cardiovasc Imaging. 2013;6(8):877–85.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Toro-salazar OH, Gillan E, O'loughlin MT, et al. Occult cardiotoxicity in childhood cancer survivors exposed to anthracycline therapy. Circ Cardiovasc Imaging. 2013;6(6):873–80.CrossRefPubMedGoogle Scholar
  20. 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. 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. 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. 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
  24. 24.
    Eng J, Mcclelland RL, Gomes AS, et al. Adverse left ventricular remodeling and age assessed with cardiac MR imaging: the multi-ethnic study of atherosclerosis. Radiology. 2016;278(3):714–22.CrossRefPubMedGoogle Scholar
  25. 25.
    Skitch A, Mital S, Mertens L, Liu P, Kantor P, Grosse-Wortmann L, et al. Novel approaches to the prediction, diagnosis and treatment of cardiac late effects in survivors of childhood cancer: a multi-centre observational study. BMC Cancer. 2017;17(1):519–27.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 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
  27. 27.
    Neilan TG, Coelho-filho OR, Pena-herrera D, et al. Left ventricular mass in patients with a cardiomyopathy after treatment with anthracyclines. Am J Cardiol. 2012;110(11):1679–86.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Jordan JH, Vasu S, Morgan TM, et al. Anthracycline-associated T1 mapping characteristics are elevated independent of the presence of cardiovascular comorbidities in cancer survivors. Circ Cardiovasc Imaging. 2016;9(8):115–20.CrossRefGoogle Scholar
  29. 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
  30. 30.
    Puntmann VO, Peker E, Chandrashekhar Y, Nagel E. T1 mapping in characterizing myocardial disease: a comprehensive review. Circ Res. 2016;119(2):277–99.CrossRefPubMedGoogle Scholar
  31. 31.
    Yi CJ, Wu CO, Tee M, Liu CY, Volpe GJ, Prince MR, et al. The association between cardiovascular risk and cardiovascular magnetic resonance measures of fibrosis: the Multi-Ethnic Study of Atherosclerosis (MESA). J Cardiovasc Magn Reson. 2015;17:15–21.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 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
  33. 33.
    Neilan TG, Coelho-filho OR, Shah RV, et al. Myocardial extracellular volume by cardiac magnetic resonance imaging in patients treated with anthracycline-based chemotherapy. Am J Cardiol. 2013;111(5):717–22.CrossRefPubMedGoogle Scholar
  34. 34.
    Heck SL, Gulati G, Ree AH, et al. Rationale and design of the prevention of cardiac dysfunction during an Adjuvant Breast Cancer Therapy (PRADA) Trial. Cardiology. 2012;123(4):240–7.CrossRefPubMedGoogle Scholar
  35. 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. 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. 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. 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
  39. 39.
    Diederichsen LP, Simonsen JA, Diederichsen AC, Kim WY, Hvidsten S, Hougaard M, et al. Cardiac abnormalities assessed by non-invasive techniques in patients with newly diagnosed idiopathic inflammatory myopathies. Clin Exp Rheumatol. 2015;33(5):706–14.PubMedGoogle Scholar
  40. 40.
    Bhatti S, Watts E, Syed F, Vallurupalli S, Pandey T, Jambekar K, et al. Clinical and prognostic utility of cardiovascular magnetic resonance imaging in myeloma patients with suspected cardiac amyloidosis. Eur Heart J Cardiovasc Imaging. 2016;17(9):970–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Pozo E, Kanwar A, Deochand R, Castellano JM, Naib T, Pazos-López P, et al. Cardiac magnetic resonance evaluation of left ventricular remodelling distribution in cardiac amyloidosis. Heart. 2014;100(21):1688–95.CrossRefPubMedGoogle Scholar
  42. 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

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal Medicine (Section on Cardiovascular Medicine)Wake Forest Health SciencesWinston-SalemUSA
  2. 2.Department of RadiologyWake Forest Health SciencesWinston-SalemUSA
  3. 3.Wake Forest Health SciencesWinston-SalemUSA

Personalised recommendations