Keywords:
Cardiac, Breast, Radioprotection / Radiation dose, MR-Diffusion/Perfusion, MR-Functional imaging, Contrast agent-intravenous, Dosimetry, Treatment effects, Biological effects, Image registration, Radiotherapy techniques
Authors:
A. Zeh, K. Kunze, T. Vitadello, C. Rischpler, M. Oechsner, M. Schwaiger, S. E. Combs, M.-N. Duma, S. G. Nekolla; Munich/DE
DOI:
10.1594/ecr2018/C-1524
Conclusion
No significant effect of the radiotherapy on structural or functional cardiac parameters was observed within the observation interval with the applied MRI technique.
In accordance to that there was no anatomical correlation verified between the irradiation dose and cardiac alterations.
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This is in contrary to several other studies,
which described cardiac alterations such as wall motion abnormalities due to myocardial perfusion defects in patients with left-sided breast irradiation2-3.
Seddon et al.4 detected perfusion deficits with a SPECT myocardial scintigraphy in 70.8% of the patients with left sided breast cancer and in 16.7% of the control group with right sided breast cancer.
All patients undertook irradiation therapy 5 years prior to the study.
Yet the perfusion deficits were described transient in some patients2-3 and our follow-up time interval is longer than 5 years4. Potentially,
the time intervals were too short.
The occurrence of the defects was associated with the irradiated volume of the left ventricle which consents with our hypothesis1.
But all of these studies2-4 were performed using nuclear scintigraphy.
For this methodology,
two limiting factors need to be considered: the spatial resolution of SPECT is only modest and no attenuation correction for SPECT imaging was utilized.
While the modest resolution could lead to missed perfusion deficits,
the well-known attenuation artifact in myocardial perfusion imaging in the anterior wall and apex of the women could limit the diagnostic certainty.
These technical limitations are avoided with the MRI approach as suggested by our group.