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Study design: Review. Population: Cancer therapy-associated cardiotoxicity. Intervention: Multimodality imaging and artificial intelligence.

March 15, 2022Open Access

Multimodality Advanced Cardiovascular and Molecular Imaging for Early Detection and Monitoring of Cancer Therapy-Associated Cardiotoxicity and the Role of Artificial Intelligence and Big Data

Key Result

Advanced multimodality imaging, including molecular and hyperpolarized MRI, along with artificial intelligence, holds promise for the early detection of cancer therapy-associated cardiotoxicity.

PICO

Population

Cancer therapy-associated cardiotoxicity

Intervention / Comparator

Multimodality imaging and artificial intelligence

Limitations

Cardiovascular disease is often an exclusion criterion in major cancer trials, resulting in under-representation.
Explaining what drives AI predictions or establishing causal inference is not a straightforward task.
Ensuring generalizability of AI models across different cancer subtypes and treatments requires vast amounts of accurately labeled data.
Barriers to advancing molecular imaging include radiation exposure, access to specialized equipment, and high costs.

Abstract

screening, as well as due to novel cancer therapies such as tyrosine kinase inhibitors and immune checkpoint inhibitions. However, similarly to older cancer therapies such as anthracyclines, these therapies have also been documented to cause cardiotoxic events including cardiomyopathy, myocardial infarction, myocarditis, arrhythmia, hypertension, and thrombosis. Imaging modalities such as echocardiography and magnetic resonance imaging (MRI) are critical in monitoring and evaluating for cardiotoxicity from these treatments, as well as in providing information for the assessment of function and wall motion abnormalities. MRI also allows for additional tissue characterization using T1, T2, extracellular volume (ECV), and delayed gadolinium enhancement (DGE) assessment. Furthermore, emerging technologies may be able to assist with these efforts. Nuclear imaging using targeted radiotracers, some of which are already clinically used, may have more specificity and help provide information on the mechanisms of cardiotoxicity, including in anthracycline mediated cardiomyopathy and checkpoint inhibitor myocarditis. Hyperpolarized MRI may be used to evaluate the effects of oncologic therapy on cardiac metabolism. Lastly, artificial intelligence and big data of imaging modalities may help predict and detect early signs of cardiotoxicity and response to cardioprotective medications as well as provide insights on the added value of molecular imaging and correlations with cardiovascular outcomes. In this review, the current imaging modalities used to assess for cardiotoxicity from cancer treatments are discussed, in addition to ongoing research on targeted molecular radiotracers, hyperpolarized MRI, as well as the role of artificial intelligence (AI) and big data in imaging that would help improve the detection and prognostication of cancer-treatment cardiotoxicity.

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