Cardiac CT reveals high prevalence of coronary artery disease in esophageal cancer eligible for radiotherapy

Figures

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  Figure 1. Study flowchart. The figure shows patient selection flowchart. Between January 2017 and June 2023, 133 patients scheduled for RT or CRT as treatment for esophageal cancer at our institution were considered for this clinical study. Of them, 90 patients were excluded based on the following ineligibility criteria: 1) irradiation fields not including the myocardium (n = 35); 2) renal dysfunction preventing the use of contrast agents (n = 17); 3) asthma (n = 4) or allergy to iodine contrast (n = 3); 4) history of ischemic heart disease (n = 5); 5) refusal to provide consent (n = 15); 6) difficulty in breath-holding for cardiac CT imaging (n = 11); and 7) cancellation of RT (n = 2). Finally, 41 patients were included for further analysis. RT: radiation therapy; CRT: chemoradiotherapy; CT: computed tomography.

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  Figure 2. Representative case of CAD assessment by comprehensive cardiac CT. The figure shows results of CAD assessment in a 70-year-old male with esophageal cancer using comprehensive cardiac CT, including (A) CCTA images (curved multiplanar reconstruction), (B) LECT images (short axis), and (C) dynamic CTP maps (short axis). On the CCTA images, significant stenoses (green arrows) in all three coronary arteries were observed. The LECT images revealed enhancement areas showing infarction (yellow arrows) in the basal lateral and apical septal walls. The dynamic CTP maps demonstrated perfusion abnormalities suggestive of myocardial ischemia in myocardial areas that did not display infarction. CAD: coronary artery disease; CT: computed tomography; CCTA: coronary computed tomography angiography; RCA: right coronary artery; LAD: left anterior descending artery; LCX: left circumflex artery; LECT: late enhancement computed tomography; CTP: computed tomography perfusion.

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  Figure 3. Distribution and severity of significant stenosis and its association with myocardial ischemia. The figure presents data on the prevalence and characteristics of significant stenosis in patients: (A) significant stenosis was present in 44% (18/41) of the patients; (B) of the patients with significant stenosis, 50% (9/18) had 1-vessel disease, 17% (3/18) had 2-vessel disease, and 33% (6/18) had 3-vessel disease; (C) significant stenosis was categorized as moderate in 50% (9/18) of patients and severe in 50% (9/18) based on the maximal stenosis severity when multiple significant stenoses were present; and (D) myocardial ischemia was observed in 50% (9/18) of the patients. Central Illustration: [Title. Caption.]