Assessment of myocardial extracellular volume on body computed tomography in breast cancer patients treated with anthracyclines

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.

Computed tomography-derived myocardial extracellular volume: an early biomarker of cardiotoxicity in esophageal cancer patients undergoing radiation therapy

“…Although this might be ideal, most oncologic follow-up CT protocols do not include delayed phase scans after the portal venous phase, in order to spare radiation exposure to the patient. A previous work [25] showed good correlations between myocardial ECV values obtained at 1, 3, and 7 min after contrast injection in breast cancer patients who underwent thoracic CT; hence, we can speculate that the portal venous phase we considered in the current work (approximately 80 s after contrast injection) allowed to measure values of relative enhancement readable as CT-derived ECV values. Secondly, most of our patients underwent combined chemoradiotherapy, making it impossible to discern the individual impact of either radiation or drug therapies.…”

Myocardial extracellular volume assessed by cardiovascular magnetic resonance may predict adverse left ventricular remodeling in rheumatic heart disease after valvular surgery

“…The ECV was calculated by combining native and post-contrast T1, and hematocrit reflecting an expanded extracellular matrix (15). Previously, Monti et al demonstrated that contrast-enhanced computed tomography also has potential value for assessing ECV (24). In recent years, researchers have reported on the application of T1 mapping technology in non-rheumatic valvular diseases, such as aortic stenosis, and aortic and mitral regurgitation.…”

Potential role of epicardial adipose tissue as a biomarker of anthracycline cardiotoxicity

“…While our population was already involved in a previous work assessing the role of myocardial extracellular volume as a biomarker of anthracycline cardiotoxicity [ 14 ], such analyses require the presence of both unenhanced and contrast-enhanced CT scans including the heart and might therefore prove less widely feasible than the sole assessment of EAT density on unenhanced scans, hence providing an edge to the use of EAT density in this context.…”

“…Moreover, we excluded all CT scans which presented artefacts that would hinder the segmentation of EAT, SAT, or VAT. Our patient population was already included in a study appraising the role of myocardial extracellular volume in anthracycline cardiotoxicity [ 14 ]. For each patient, we retrieved demographical, BC, staging, and treatment data.…”