Increased cardiac uptake of (18F)-fluorodeoxyglucose incidentally detected on positron emission tomography after left breast irradiation: How to interpret?

Eber, Jordan; Leroy-Freschini, Benjamin; Antoni, D.; Noël, G.; Pflumio, Carole

doi:10.1016/j.canrad.2021.10.010

Cited by 5 publications

(5 citation statements)

References 56 publications

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“…Compared to FB-3DCRT, FB-HT also significantly reduced LV-V 5Gy EQD2, which appeared to be the most important prognostic dose–volume parameter [ 23 ]. The reduction in D max to the heart, LV, and LADA could have clinical benefits, as suggested by previous studies that found subclinical changes detected with early imaging after a high dose to the myocardium [ 34 , 35 , 36 , 37 , 38 ]. Evans et al found that the amount of heart tissue exposed to 20 Gy correlated with increased focal cardiac FDG uptake [ 39 ].…”

Section: Discussionmentioning

confidence: 86%

Evaluation of Cardiac Substructures Exposure of DIBH-3DCRT, FB-HT, and FB-3DCRT in Hypofractionated Radiotherapy for Left-Sided Breast Cancer after Breast-Conserving Surgery: An In Silico Planning Study

Eber

Schmitt

Dehaynin

et al. 2023

Cancers

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Left-sided breast cancer radiotherapy can lead to late cardiovascular complications, including ischemic events. To mitigate these risks, cardiac-sparing techniques such as deep-inspiration breath-hold (DIBH) and intensity-modulated radiotherapy (IMRT) have been developed. However, recent studies have shown that mean heart dose is not a sufficient dosimetric parameter for assessing cardiac exposure. In this study, we aimed to compare the radiation exposure to cardiac substructures for ten patients who underwent hypofractionated radiotherapy using DIBH three-dimensional conformal radiation therapy (3DCRT), free-breathing (FB)-3DCRT, and FB helical tomotherapy (HT). Dosimetric parameters of cardiac substructures were analyzed, and the results were statistically compared using the Wilcoxon signed-rank test. This study found a significant reduction in the dose to the heart, left anterior descending coronary artery, and ventricles with DIBH-3DCRT and FB-HT compared to FB-3DCRT. While DIBH-3DCRT was very effective in sparing the heart, in some cases, it provided little or no cardiac sparing. FB-HT can be an interesting treatment modality to reduce the dose to major coronary vessels and ventricles and may be of interest for patients with cardiovascular risks who do not benefit from or cannot perform DIBH. These findings highlight the importance of cardiac-sparing techniques for precise delivery of radiation therapy.

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Section: Discussionmentioning

confidence: 86%

Evaluation of Cardiac Substructures Exposure of DIBH-3DCRT, FB-HT, and FB-3DCRT in Hypofractionated Radiotherapy for Left-Sided Breast Cancer after Breast-Conserving Surgery: An In Silico Planning Study

Eber

Schmitt

Dehaynin

et al. 2023

Cancers

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“…Twelve beagles received two regimens before PET-CT, after fasting for 12 h, and after receiving a high-fat diet after fasting for 12 h. Compared with pathology, the high uptake of FDG in the radiation field was considered to be related to radiation-induced myocardial damage caused by microvascular and mitochondrial damage. Eber et al [82] reported a patient with breast cancer in whom an increase in [ 18 F]-FDG uptake was accidentally detected by positron emission tomography (PET) after radiotherapy, and technetium-99m tetrofosmin SPECT imaging showed a mild reversible perfusion defect. The clinical examination was asymptomatic, and the patient had normal angiography results, suggesting a radiation-induced hibernating myocardium.…”

Section: F]-fluorodeoxyglucose (Fdg) Pet Myocardial Metabolism Imagingmentioning

confidence: 99%

“…Eber et al. [82] reported a patient with breast cancer in whom an increase in [ 18 F]‐FDG uptake was accidentally detected by positron emission tomography (PET) after radiotherapy, and technetium‐99m tetrofosmin SPECT imaging showed a mild reversible perfusion defect. The clinical examination was asymptomatic, and the patient had normal angiography results, suggesting a radiation‐induced hibernating myocardium.…”

Section: Multimodal Imagingmentioning

confidence: 99%

Advances in multimodality imaging and the application of new cardiac imaging technologies for radiation‐induced heart disease

Du,

Lan,

Shen

et al. 2024

iRADIOLOGY

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Radiation‐induced heart disease (RIHD) is a heterogeneous, delayed, and potentially fatal adverse reaction to radiation that can damage all structures of the heart, including the pericardium, myocardium, coronary arteries, valves, and conduction system, leading to a series of diseases. Acute and chronic disease processes play a role in the development of RIHD, the onset times of which range from months to decades. However, the clinical manifestations of RIHD are usually insidious, overlap with several other diseases, and lack specificity. Cardiovascular imaging is essential for early diagnosis, follow‐up, and outcome assessment in patients with RIHD. This review first describes the pathogenesis and clinical manifestations of RIHD before providing an overview of the practical approaches and research advances in multimodal cardiovascular imaging in patients with RIHD, including echocardiography, cardiac magnetic resonance (CMR) and nuclear medicine, and cardiac computed tomography (CT). Then, the value of new cardiac imaging assessments for the early diagnosis of RIHD is described, particularly with relation to speckle‐tracking echocardiography, extracellular volume fraction assessment as a quantitative CMR technique, CMR myocardial strain assessment, positron emission tomography‐CT myocardial perfusion imaging, CT‐ECV, and CT strain assessment, amongst others. In addition, the advantages and disadvantages of each screening technique are compared with the aim of better guiding the follow‐up and diagnosis of subclinical RIHD and preventing cardiovascular events.

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“…Using a glucose analogue, [ 18 F]-fluorodeoxyglucose ( 18 FDG) positron emission tomography ([ 18 F]-FDG-PET/CT) provides a unique assessment of myocardial metabolism by detecting changes in cardiomyocytes at an early stage before cardiotoxicity. Uptake of 18 FDG correlates with changes in the cellular myocardial metabolism together with inflammation extent within the coronary arteries wall, preceding possible atherosclerotic plaque rupture and could also reflect macrophages content within the vulnerable plaque (19)(20)(21). Due to glucose's role as an auxiliary energy source, PET examinations typically necessitate specific metabolic preparation in patients to achieve hyperinsulinemic euglycemia.…”

Section: Myocardial Metabolismmentioning

confidence: 99%

Nuclear medicine imaging methods of early radiation-induced cardiotoxicity: a ten-year systematic review

Eber,

Blondet,

Le Fevre

et al. 2023

Front. Oncol.

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IntroductionRadiotherapy has significantly improved cancer survival rates, but it also comes with certain unavoidable complications. Breast and thoracic irradiation, for instance, can unintentionally expose the heart to radiation, leading to damage at the cellular level within the myocardial structures. Detecting and monitoring radiation-induced heart disease early on is crucial, and several radionuclide imaging techniques have shown promise in this regard. MethodIn this 10-year review, we aimed to identify nuclear medicine imaging modalities that can effectively detect early cardiotoxicity following radiation therapy. Through a systematic search on PubMed, we selected nineteen relevant studies based on predefined criteria. ResultsThe data suggest that incidental irradiation of the heart during breast or thoracic radiotherapy can cause early metabolic and perfusion changes. Nuclear imaging plays a prominent role in detecting these subclinical effects, which could potentially serve as predictors of late cardiac complications.DiscussionHowever, further studies with larger populations, longer follow-up periods, and specific heart dosimetric data are needed to better understand the relationship between early detection of cardiac abnormalities and radiation-induced heart disease.

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Increased cardiac uptake of (18F)-fluorodeoxyglucose incidentally detected on positron emission tomography after left breast irradiation: How to interpret?

Cited by 5 publications

References 56 publications

Evaluation of Cardiac Substructures Exposure of DIBH-3DCRT, FB-HT, and FB-3DCRT in Hypofractionated Radiotherapy for Left-Sided Breast Cancer after Breast-Conserving Surgery: An In Silico Planning Study

Evaluation of Cardiac Substructures Exposure of DIBH-3DCRT, FB-HT, and FB-3DCRT in Hypofractionated Radiotherapy for Left-Sided Breast Cancer after Breast-Conserving Surgery: An In Silico Planning Study

Advances in multimodality imaging and the application of new cardiac imaging technologies for radiation‐induced heart disease

Nuclear medicine imaging methods of early radiation-induced cardiotoxicity: a ten-year systematic review

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