Left Ventricular T1 Mapping during Chemotherapy–Radiation Therapy: Serial Assessment of Participants with Esophageal Cancer

Abstract

Purpose To assess changes in left ventricular function and tissue composition by using MRI after chemotherapy-radiation therapy in participants with esophageal cancer. Materials and Methods Between January 2013 and April 2015, this prospective study enrolled 24 participants (42% women; mean age, 63 years; range, 49-73 years) scheduled for chemotherapy-radiation therapy. 3.0-T MRI examinations were performed before, at 0.5 year, and at 1.5 years after chemotherapy-radiation therapy. Myocardial native T1, postcontrast T1, and extracellular volume were measured in basal septum (as irradiated areas) and apical lateral wall (as nonirradiated areas). Left ventricular function, prevalence of late gadolinium enhancement, and T1 and extracellular volume values were compared over the follow-up period by using Friedman or Cochran Q tests, followed by Dunn test. Results In 14 participants who were followed up for 1.5 years, native T1 and extracellular volume in the septum were elevated at 0.5 year compared with baseline (1183 msec ± 46 [standard deviation] vs 1257 msec ± 35; 26% ± 3 vs 32% ± 3; adjusted P < .01 for both), but not in the lateral wall. Left ventricular stroke volume index and late gadolinium enhancement changed at 1.5 years compared with baseline (41 mL/m ± 11 vs 36 mL/m ± 9; P = .046; 7% [one of 14] vs 78% [11 of 14]; P < .01). Other measures of left ventricular function did not change during the follow-up period (P > .10 for all). Conclusion Native T1 and extracellular volume could detect early changes in myocardium at 0.5 year after chemotherapy-radiation therapy, whereas left ventricular stroke volume index and late gadolinium enhancement showed abnormality at 1.5 years. © RSNA, 2018 Online supplemental material is available for this article.

A Prospective Study of Early Radiation Associated Cardiac Toxicity Following Neoadjuvant Chemoradiation for Distal Esophageal Cancer

“…They obtained CMR at baseline, 0.5 and 1.5 years and found that early imaging changes in myocardial tissue at 0.5 years preceded changes in LV stroke volume index that occurred at 1.5 years. The changes were most pronounced in the basal septum and occurred in areas that received higher radiation dose although the percent change from baseline did not correlate with radiation dose (24). Importantly, Takagi et al and our study both demonstrate that the basal septum possibly has increased susceptibility to radiation induced damage.…”

Cardiac MRI utilizing late gadolinium enhancement (LGE) and T1 mapping in the detection of radiation induced heart disease

“…Mean T1 values for CMR at baseline prior to radiotherapy were 1183 ms (+/− 46); however, values taken at the basal septum which received sizeable radiation doses were significantly elevated above baseline pretreatment values (0.5 years = 1257 ms (p < 0.01), 1.5 years = 1238 ms (p = 0.024)). Interestingly, the left lateral ventricle segment, which would have been outside of the traditional 3D conformal field and received only low dose, did not see differences between pre-treatment and post-treatment T1 values [44].…”

Cardiac MRI utilizing late gadolinium enhancement (LGE) and T1 mapping in the detection of radiation induced heart disease

“…Mean T1 values for CMR at baseline prior to radiotherapy were 1183 ms (+/-46); however, values taken at the basal septum which received sizeable radiation doses were signi cantly elevated above baseline pretreatment values (0.5 years = 1257 ms (p<0.01), 1.5 years = 1238 ms (p=0.024)). Interestingly, the left lateral ventricle segment, which would have been outside of the traditional 3D conformal eld and received only low dose, did not see differences between pre-treatment and posttreatment T1 values [44]. The time to the development of cardiac brosis is not known, but it is assumed to develop within 6 months after radiotherapy and is not reversible once deposited.…”