Key result
Cardiac computed tomography successfully detected and quantified myocardial fibrosis (extracellular volume fraction 35.8%), consistent with cardiac magnetic resonance imaging (35.3%) in a patient with CTRCD.
Why the study?
Cardiac computed tomography (CT) imaging for detection and quantification of myocardial fibrosis in cancer therapy-related cardiac dysfunction (CTRCD) has not been well established.
Case Report (n=1)
Cardiac CT utilizing late iodine enhancement and extracellular volume fraction analyses can be a useful alternative to CMR for detecting and quantifying myocardial fibrosis in cancer therapy-related cardiac dysfunction.
CT may support fibrosis assessment by CT in CTRCD when CMR is unavailable; leaves open need for validation before clinical adoption.
A 66-year-old female patient received a diagnosis of breast cancer. She underwent bilateral mastectomies and was indicated for postoperative chemotherapy. Pretreatment transthoracic echocardiography (TTE) revealed a normal systolic left ventricular (LV) function [LV ejection fraction (LVEF), 65%]. Adjuvant combination chemotherapy with epirubicin (total 400 mg/m2) and cyclophosphamide (total 2000 mg/m2) was administered. Then, she received docetaxel (total 300 mg/m2), followed by total 104 mg/kg trastuzumab. Fifteen months after the initiation of her chemotherapy, she was admitted to a hospital and diagnosed with acute decompensated heart failure. LVEF determined by TTE fell to 40%, and she was diagnosed with cancer therapy-related cardiac dysfunction (CTRCD). Obstructive coronary artery disease was excluded by coronary computed tomography (CT) angiography. Delayed phase cardiac CT revealed right ventricular insertion point late iodine enhancement (LIE) (Panel A: LIE image, arrowhead) which represents focal myocardial fibrosis, and myocardial global extracellular volume fraction (ECV) by CT was 35.8% (Panel B: CT-ECV map), suggesting the presence of diffuse fibrosis. These findings were consistent with the cardiac magnetic resonance imaging (CMR) results [Panel C: late gadolinium enhancement (LGE) image and Panel D: CMR-ECV map, global ECV = 35.3%]. Cardiac CT was helpful in detection and quantification of myocardial fibrosis that can be a feature of CTRCD. CT imaging allows evaluation of CTRCD utilizing LIE and ECV analyses. This novel CT imaging can be performed in conjunction with standard coronary artery evaluation and cancer follow-up. We believe this technology could be useful for the ‘one-stop shop’ evaluation of CTRCD. Consent: The author/s confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from the patient in line with COPE guidance.
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Sueta et al. (2020) conducted a case report in Cancer therapy-related cardiac dysfunction (CTRCD) (n=1). Cardiac computed tomography (CT) vs. Cardiac magnetic resonance imaging (CMR) was evaluated on Detection and quantification of myocardial fibrosis (late iodine enhancement and extracellular volume fraction). Cardiac computed tomography successfully detected and quantified myocardial fibrosis (extracellular volume fraction 35.8%), consistent with cardiac magnetic resonance imaging (35.3%) in a patient with CTRCD.
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