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
Aims and objectives
Several studies reported an increased rate of cardiac events related to left-sided breast irradiation1-4. The purpose of this study is to improve our understanding of the nature of radiation effects on the human organism in general and on the heart in particular by detecting cardiac alterations prior to clinical symptoms and,
potentially,
to optimize means of early intervention.
In the last three decades radiobiological studies have shown that late myocardial irradiation damages can eventually cause coronary heart disease through a process which is not yet fully understood.
According to the current state of research the late damages of radiotherapy are not simply a decay of specific cells,
if not a complex and dynamic interaction between several cell types within an organ5-8.
Pharmacological intervention attempts to stop those processes so that a subclinical defect might not conclude in a manifest clinical disease9.
Radiotherapy in the thoracic area can have acute as well as late effects on the heart provided that cardiovascular structures lie within or in immediate proximity of the irradiation field10. Breast cancer patients are especially endangered to develop myocardial damage. This is due to their long life expectancy,
the proximity of the breast irradiation field to cardiovascular structures and frequent use of Anthracyclin-based chemotherapy.
In general it takes about ten years until the first consequences appear11 but modern imaging techniques have the potential to enable premature detection of irradiation associated damages.
To investigate the cardiac defects caused by radiotherapy we delineated the relation between the anatomical distribution of the irradiation dose and occurrence of cardiac alterations in that area by using non-invasive MR imaging.