LVEF by Multigated Acquisition Scan Compared to Other Imaging Modalities in Cardio-Oncology: a Systematic Review

Abstract

Purpose of Review The prevalence of cancer therapy-related cardiac dysfunction (CTRCD) is increasing due to improved cancer survival. Serial monitoring of cardiac function is essential to detect CTRCD, guiding timely intervention strategies. Multigated radionuclide angiography (MUGA) has been the main screening tool using left ventricular ejection fraction (LVEF) to monitor cardiac dysfunction. However, transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR) may be more suitable for serial assessment. We aimed to assess the concordance between different non-radiating imaging modalities with MUGA to determine whether they can be used interchangeably. Recent Findings In order to identify relevant studies, a PubMed search was performed. We included cross-sectional studies comparing MUGA LVEF to that of 2D TTE, 3D TTE, and CMR. From 470 articles, 22 were selected, comprising 1017 patients in total. Among others, this included three 3D TTE, seven 2D harmonic TTE + contrast (2DHC), and seven CMR comparisons. The correlations and Bland-Altman limits of agreement varied for CMR but were stronger for 3D TTE and 2DHC. Summary Our findings suggest that MUGA and CMR should not be used interchangeably whereas 3D TTE and 2DHC are appropriate alternatives following an initial MUGA scan. We propose a multimodality diagnostic imaging strategy for LVEF monitoring in patients undergoing cancer treatment.

Artificial intelligence-enhanced risk stratification of cancer therapeutics-related cardiac dysfunction using electrocardiographic images

“…First, our model, which is freely available online and directly accessible to any user, 28 enables direct screening for a label of cardiac function that has traditionally required echocardiography, cardiovascular magnetic resonance or nuclear multi-gated acquisition scans for its accurate quantification. 43 This provides an inexpensive, yet globally available technology for the monitoring and risk stratification of some of the most common forms of cancer and widely used agents in oncology. Second, unlike previously described and validated algorithms that rely on ECG signals, 12, 42 our approach may use any real-world ECG image as input.…”

Tales from the future—nuclear cardio-oncology, from prediction to diagnosis and monitoring

“… 14 While only echocardiography and CMR can estimate GLS, 46 MUGA robustly determines LVEF. 47 , 48 In MUGA, cardiac volumes are derived from heart-centred images of the patient’s own radiolabelled erythrocytes 49 and are therefore not influenced by geometric assumptions about the myocardial wall. 50 Three types of MUGA are distinguished: (i) first-pass MUGA, (ii) planar equilibrium radionuclide angiography (ERNA), and (iii) single-photon emission computed tomography (SPECT) ERNA.…”

“…Compared with CMR, 2D and 3D TTE tend to underestimate LV volumes. 84 Similarly, limits of agreement between MUGA and CMR often exceed ±10%, 48 which could lead to incorrectly classifying patients with CTRCD. In this regard, MUGA’s radiation exposure argues against its systematic use for the follow-up of patients undergoing anticancer treatment.…”

Multimodality Imaging in Advanced Heart Failure for Diagnosis, Management and Follow-Up: A Comprehensive Review

“…Multigated acquisition nuclear imaging (MUGA), also known as radionucleotide ventriculography (RVG) and gated equilibrium radionucleotide angiography (ERNA), emerges as a valuable third-line option when echocardiography and CMR are unavailable for LVEF assessment [51,52]. Despite its high reproducibility and minimal variability, concerns persist about radiation exposure, particularly in young patients [51,52].…”

“…Ongoing research, including modalities like MUGA, contributes to refining our understanding of their comparative utility and guides their optimal integration into cardiovascular care [50][51][52][53]. Additionally, the inclusion of modalities like MUGA enhances the cardiovascular imaging landscape, providing valuable insights for comprehensive patient care and management [54].…”