Cardiac MRI for the evaluation of oncologic cardiotoxicity

Abstract

Cancer therapeutics-related cardiac dysfunction (CTRCD) is a well-established adverse effect resulting from a number of cancer therapeutics. Newer immunotherapy has been associated with cardiomyopathy and myocarditis making comprehensive imaging useful for early recognition. Cardiac MRI (CMR) offers a comprehensive evaluation to detect CTRCD. Established guidelines for monitoring left ventricular ejection fraction for potential cardiotoxicity have recently incorporated CMR. We will review the utility of CMR in contemporary evaluation for potential oncologic cardiotoxicity.

MRI in cardio‐oncology: A review of cardiac complications in oncologic care

“…MRI is especially valuable to evaluate the pericardium, as several sequences may be helpful for a comprehensive evaluation. Using a short‐tau inversion‐recovery (STIR) sequence on T 2 ‐weighted spin‐echo imaging can demonstrate pericardial fluid and edema of the pericardial layers in inflammatory pericarditis, while tagged cine gradient sequences can detect myocardial involvement in constrictive pericarditis and fibrotic adhesion of the pericardium . Figure demonstrates the MRI presentation of therapy‐related pericarditis in mild and severe cases.…”

“…Figure demonstrates the MRI presentation of therapy‐related pericarditis in mild and severe cases. Free‐breathing cine imaging can also be used to evaluate ventricular interdependence . Additionally, Mukai‐Yatagai et al demonstrated native and postcontrast T 1 mapping by MRI could be used to estimate ECV and evaluate for myocardial fibrosis following radiation therapy .…”

“…Nevertheless, LVEF has long been used to assess cardiac systolic function and can be reliably measured on MRI on contiguous short-axis series of slices through the cardiac apex to base using bSSFP cine bright blood imaging techniques. 29,30 Early studies detected declines in LVEF after anthracycline treatment utilizing other imaging modalities such as radionuclide multiple-gated acquisition, transthoracic echocardiography (TTE), and cardiac computed tomography. 29,31,32 The advancement of MRI has delivered an accurate and reproducible test for measuring ventricular volume, mass, and ejection fraction.…”

“…[81][82][83] Correspondingly, a growing number of reports have demonstrated the role of MRI as the primary noninvasive modality to evaluate myocarditis in the cancer population. 30,79,83,84 In a study by Mahmood et al of 35 patients with immune checkpoint inhibitor associated myocarditis, 31 patients had cardiac MRI performed and 20 patients displayed characteristic LGE that was utilized to diagnose myocarditis along with elevated troponin. 83 Figures 5 and 6 illustrate cases of cancer therapeutics-related myocarditis.…”

“…Using a short-tau inversion-recovery (STIR) sequence on T 2weighted spin-echo imaging can demonstrate pericardial fluid and edema of the pericardial layers in inflammatory pericarditis, while tagged cine gradient sequences can detect myocardial involvement in constrictive pericarditis and fibrotic adhesion of the pericardium. 30,93,94 Figure 8 demonstrates the MRI presentation of therapy-related pericarditis in mild and severe cases. Free-breathing cine imaging can also be used to evaluate ventricular interdependence.…”