Cardiovascular Magnetic Resonance Imaging in the Early Detection of Cardiotoxicity Induced by Cancer Therapies

Figures

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  Figure 1. Overview of the pathological changes of cardiomyocytes in cardiotoxicity induced by cancer therapies, the resulting morphological and functional changes of the heart, and CMR assessments that have been performed in previous studies. Different CMR parameters may increase (red arrows) or decrease (blue arrows) or be positive (red plus) in cardiotoxicity. LV = left ventricular; LVEF = left ventricular ejection fraction; LVESV = LV end-systolic volume; LVEDV = LV end-diastolic volume; GLS = global longitudinal strain; RVEF = right ventricular ejection fraction; T1WI = T1-weighted imaging; T2WI = T2-weighted imaging; LGE = late gadolinium enhancement; ECV = extracellular volume fraction.

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  Figure 2. (A–C) A 61-year-old man with multiple myeloma who had undergone 4 cycles of chemotherapy within 5 months (bortezomib 2.25 mg, lenalidomide 25 mg, and dexamethasone 40 mg). (A) LVEF calculated from cine images was normal (68.2%). (B) LGE image showing an intramural, slightly hyperintense signal in the ventricular septum (arrow). (C) Native T1 mapping showing a larger T1 value for the ventricular septum than that of the lateral wall (1274 ms and 1173 ms, respectively). (D,E) A 62-year-old woman with multiple myeloma for 6 years. The chemotherapy regimen included 5 cycles of CTD (cyclophosphamide 1.2 g, thalidomide 200 mg, and dexamethasone 20 mg), 2 cycles of VTD (bortezomib 2.3 mg, thalidomide 100 mg, and dexamethasone 17 mg), and 2 cycles of VRD (bortezomib 2.3 mg, lenalidomide 25 mg, and dexamethasone 17 mg). The electrocardiogram showed a prolonged QT interval. (D) LGE image demonstrating a slightly hyperintense lesion in the LV inferior wall (arrow). (E) Native T1 mapping showing a significantly larger T1 value for the lesion compared to that of lateral wall (1568 ms and 1232 ms, respectively). (F) No significant increase in the T2 value was found in the T2 mapping, suggesting…

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  Figure 3. Animal model of anthracycline cardiotoxicity. (A) Time course of CMR imaging studies in pig model that received 5 biweekly doxorubicin injections and follow-up to week 16. Data are represented as mean ± SD (bars); (B) Individual animal data at selected time points for LVEF, T2, and ECV. Asterisks indicate statistically significant differences compared with week 0: * p < 0.05, ** p < 0.01. Reprinted with permission from Ref. [40]. 2019, Elsevier.