IRM cardiaque en cancérologie: le rôle du radiologue
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1 IRM cardiaque en cancérologie: le rôle du radiologue Laurent MACRON Centre Cardiologique du Nord (CCN) Saint Denis Centre Cardiologique du Nord - Saint Denis - France
2 CMR in oncology Characterisation of cardiac masses Infiltrative cardiomyopathies in oncology Amyloidosis Iron overload Cardiovascular complications of cancer therapy Centre Cardiologique du Nord - Saint Denis - France
3 CMR in oncology Characterisation of cardiac masses CMR PROTOCOL FOR CARDIAC MASSES Black blood sequences (T1 w/o fat sat, T1 fat sat, T2) First Pass Perfusion Cine SSFP LGE BENIGN PRIMARY CARDIAC TUMORS Myxoma Papillary Fibroelastoma Lipoma Fibroma Rhabdomyoma Hemangioma MALIGNANT CARDIAC TUMORS Angiosarcoma Rhabdomyosarcoma Lymphoma Other sarcoma Metastasis Centre Cardiologique du Nord - Saint Denis - France
4 Cardiovascular complications of cancer therapies (ESC position paper on cancer treatments and cardiovascular toxicity) 1. myocardial dysfunction and heart failure (HF); 2. coronary artery disease (CAD); 3. valvular disease; 4. arrhythmias, especially those induced by QTprolonging drugs; 5. arterial hypertension; 6. thromboembolic disease; 7. peripheral vascular disease and stroke; 8. pulmonary hypertension and 9. pericardial complications. Centre Cardiologique du Nord - Saint Denis - France
5 Myocardial dysfunction related to use of cancer therapeutics = decrease in LVEF of more than 10% to a value below 50% and confirmed by repeat cardiac imaging performed 2 to 3 weeks later Timing and severity depend on agent, dosing and patient-rebated factors Centre Cardiologique du Nord - Saint Denis - France
6 Baseline risk factors for myocardial dysfunction Centre Cardiologique du Nord - Saint Denis - France
7 Centre Cardiologique du Nord - Saint Denis - France
8 Kaplan Meier curve showing the cumulative incidence of cardiotoxicity in the study population. Daniela Cardinale et al. Circulation. 2015;131: Copyright American Heart Association, Inc. All rights reserved.
9 Left ventricular ejection fraction (LVEF; mean±sd) behavior in patients developing cardiotoxicity in the first year, from baseline (before starting chemotherapy) to the initiation of heart failure therapy. Daniela Cardinale et al. Circulation. 2015;131: Copyright American Heart Association, Inc. All rights reserved.
10 Left ventricular ejection fraction (LVEF) in patients with cardiotoxicity and with partial (triangle) or full (square) recovery with heart failure therapy. Daniela Cardinale et al. Circulation. 2015;131: Copyright American Heart Association, Inc. All rights reserved.
11 Baseline risk factors for myocardial dysfunction Centre Cardiologique du Nord - Saint Denis - France
12 Manrique CR et al Diagnostic Strategies for Early Recognition of Cancer Therapeutics-Related Cardiac Dysfu 2017
13 HOW TO DETECT CARDIOTOXICITY
14 LV/RV volumes and EF assessment Cine SSFP sequence: -Volumetric assessment -Contrast resolution between LV cavity/myocardium -Temporal R. (25ms) -Spatial R (<2mm in plane) Advantages relative to other imaging modalities -More accurate (no geometrical assumption) -More reproducible -No acoustic window limitation (TTE) -No ionizing radiation (SPECT) CMR = Gold Standard for LV/RV volumes and EF Mc Murray JJ et al ESC Guidelines Heart Failure Eur Heart J 2012 Centre Cardiologique du Nord - Saint Denis - France
15 Centre Cardiologique du Nord - Saint Denis - France
16 Cardiac MRI in the Assessment of Cardiac Injury and Toxicity From Cancer Chemotherapy by Paaladinesh Thavendiranathan, Bernd J. Wintersperger, Scott D. Flamm, and Thomas H. Marwick Circ Cardiovasc Imaging Volume 6(6): November 19, 2013 Copyright American Heart Association, Inc. All rights reserved.
17 Early gadolinium enhancement in a patient with breast cancer receiving adjuvant trastuzumab therapy referred with concern of cardiotoxicity. Paaladinesh Thavendiranathan et al. Circ Cardiovasc Imaging. 2013;6: Copyright American Heart Association, Inc. All rights reserved.
18 T2 maps at the basal, mid, and apical slices (A C) and T1 map in the basal slice (D; in a patient with breast cancer referred for cardiotoxicity asymptomatic during adjuvant trastuzumab therapy). Paaladinesh Thavendiranathan et al. Circ Cardiovasc Imaging. 2013;6: Copyright American Heart Association, Inc. All rights reserved.
19 Myocardial strain analysis using a feature-tracking algorithm in the same patient as in Figure 2. Paaladinesh Thavendiranathan et al. Circ Cardiovasc Imaging. 2013;6: Copyright American Heart Association, Inc. All rights reserved.
20 Delayed enhancement imaging in the same patient as in Figure 3, illustrating a focal area of midmyocardial enhancement (arrows) involving the basal inferior septum seen in both short-axis (A) and 4-chamber (B) views. Paaladinesh Thavendiranathan et al. Circ Cardiovasc Imaging. 2013;6: Copyright American Heart Association, Inc. All rights reserved.
21 A C, Extracellular volume (ECV) quantification in the patient from Figure 2. Paaladinesh Thavendiranathan et al. Circ Cardiovasc Imaging. 2013;6: Copyright American Heart Association, Inc. All rights reserved.
22 Manrique CR et al Diagnostic Strategies for Early Recognition of Cancer Therapeutics-Related Cardiac Dysfu 2017
23 Manrique CR et al Diagnostic Strategies for Early Recognition of Cancer Therapeutics-Related Cardiac Dysfu 2017
24 Manrique CR et al Diagnostic Strategies for Early Recognition of Cancer Therapeutics-Related Cardiac Dysfu 2017
25 CMR in oncology Savoir caractériser les lésions tumorales cardiaques Penser à l amylose et à l hémochromatose post transfusionnelle Ne pas méconnaitre la cardiotoxicité des chimiothérapies Importance de l évaluation pré-thérapeutique - identification des patients à risque - le patient est son propre témoin Participation au RCP - développement d unité de cardio-oncologie Centre Cardiologique du Nord - Saint Denis - France
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