Key result
Cardiac radiation doses show no association with LGE or T1 mapping values on cardiac MRI.
Why the study?
Radiotherapy is associated with late dose-dependent cardiovascular toxicity, but early markers of myocardial damage detectable by cardiac MRI are not well established.
Does cardiac MRI utilizing LGE and T1 mapping detect early markers of myocardial damage correlated with radiation dose in patients treated for chest tumors?
Cross-Sectional (n=28)
No
Does cardiac MRI utilizing LGE and T1 mapping detect early markers of myocardial damage correlated with radiation dose in patients treated for chest tumors?
Absolute Event Rate: 60.8% vs 46.1%
p-value: p=0.16
In this pilot study, cardiac MRI utilizing LGE and T1 mapping did not show a significant correlation with cardiac radiation doses in patients treated for chest tumors.
No association between radiation dose and MRI fibrosis markers; leaves open the utility of cardiac MRI for post-radiotherapy surveillance.
Background and Purpose Radiotherapy has been associated with late dose-dependent cardiovascular toxicity. In this cross-sectional pilot study, radiation dose distributions were correlated with areas of localized and diffuse myocardial fibrosis as measured by novel cardiac MRI (CMR) sequences including late gadolinium enhancement (LGE) and T1 mapping with the goal to identify early markers of myocardial damage. Materials and Methods Twenty-eight patients with chest tumors including lung, breast, esophagus, and lymphoma underwent CMR per study protocol on average 46.4 months (range 1.7-344.5) after radiotherapy. Patients without pretreatment cardiac history were included if the volume of heart receiving 5 Gy or more was at least 10% (V5Gy≥10%). The association of LGE with cardiac dosimetric factors, clinical factors (e.g., tumor type, smoking history, BMI), , and T1 values was analyzed. Results Cardiac maximum (Dmax) and mean dose (Dmean) equivalent to doses delivered in 2 Gy fractions (EQD2) were on average 50.9 Gy (range 6.2-108.0) and 8.2 Gy (range 1.0-35.7), respectively, compared to 60.8 Gy (40.8-108.0) and 6.8 Gy (1.8-21.8) among the 9 patients with LGE. Doses were not different between patients with and without LGE (p=0.16 and 0.56, respectively). The average T1 value of the left ventricle myocardium was 1009 ms (range 933-1117). No significant correlation was seen for heart Dmax and Dmean and T1 values (p=0.14 and 0.58, respectively). In addition, no significant association between clinical factors and the development of LGE was identified. Conclusions No relation between cardiac doses, the presence of LGE or T1 values was observed. Further study is needed to determine the benefit of CMR for detecting radiotherapy-related myocardial fibrosis.
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Ricco et al. (2020) conducted a cross-sectional in Previous thoracic radiotherapy for chest tumors (n=28). Cardiac radiation dose vs. Patients without LGE was evaluated on Difference in cardiac maximum dose (Dmax EQD2) between patients with and without late gadolinium enhancement (LGE) (p=0.16). Cardiac radiation doses were not significantly associated with the presence of late gadolinium enhancement or T1 mapping values on cardiac MRI in patients previously treated with thoracic radiotherapy.
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