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Kardioonkologie – was leistet die MRT?

Inflammation, Fibrose, Outcome

Cardiooncology—usefulness of cardiac MRI

Inflammation, fibrosis, outcome

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Zusammenfassung

Hintergrund

Durch verbesserte Überlebenschancen bei vielen Krebserkrankungen werden die Patient*innen nach einer Chemo- oder Radiotherapie immer häufiger mit den Nebenwirkungen der eingesetzten Therapeutika konfrontiert. Diese potenziell kardiotoxischen Effekte können, falls nicht frühzeitig detektiert, zu einer irreversiblen Herzinsuffizienz führen.

Fragestellung

Dieser Artikel soll den derzeitigen Wissensstand zu dem Nutzen der kardialen Magnetresonanztomographie (MRT) auf dem Gebiet der Kardioonkologie darstellen und einen Überblick über die Vorteile der MRT zur Analyse von Herzfunktion und von entzündlichen und fibrotischen Veränderungen des Myokards geben.

Material und Methoden

Zuerst erfolgten eine Analyse und Auswertung der bisherigen Studienlage. Expertenempfehlungen aus verschiedenen Positionspapieren wurden ausgewertet und subsummiert. Zuletzt wurde ein MRT-Protokoll für kardioonkologische Fragestellungen diskutiert.

Ergebnisse

Bis zu 20 % der Patient*innen leiden an kardiotoxischen Komplikationen einer Chemotherapie oder Bestrahlung. Besonders bei Patient*innen mit kardiovaskulären Risikofaktoren wird eine prä- und posttherapeutische Messung der Herzfunktion angeraten. Die kardiale MRT wird bei insuffizienter echokardiographischer Bildqualität zur Funktionsanalyse empfohlen, jedoch stellt sie auch eine exzellente Methode zur weiterführenden Gewebeanalyse dar.

Diskussion

Die bisherigen Positionspapiere empfehlen die kardiale MRT als Ausweichmöglichkeit, falls echokardiographische Untersuchungen unzureichend sind. Besonders Patient*innen mit einer Reduktion der echokardiographisch gemessenen Herzfunktion könnten von einer frühzeitigen Einschätzung von entzündlichen oder narbigen Veränderungen mittels kardialer MRT profitieren.

Abstract

Background

With rapidly increasing survival chances of cancer patients, the potential side effects of cancer therapeutics are increasingly relevant and a potentially lifelong issue. If cardiotoxic effects are not detected at a reversible stage, this might result in irreversible heart failure.

Objectives

This article will portray the current state of knowledge on the use of cardiac magnetic resonance imaging (cardiac MRI) in the field of cardio-oncology. The aim is to provide an overview of the advantages of cardiac MRI to determine myocardial function and analyze inflammatory or fibrotic myocardial changes.

Materials and methods

Current studies on this topic were collected and evaluated. Expert recommendations from various position papers were reviewed and summarized. Lastly, an MRI protocol to assess potential cardiotoxic effects of cancer therapeutics was discussed.

Results

Up to 20% of patients are reported to suffer from cancer therapeutics-related cardiac dysfunction (CTRCD). Especially those with cardiovascular risk factors should receive pre- and posttherapeutic monitoring of heart function. Cardiac MRI is currently suggested as an imaging tool to analyze myocardial function if echocardiographic assessment is insufficient. However, cardiac MRI is also an excellent method for additional tissue analysis.

Conclusion

Current consensus statements recommend cardiac MRI as optional in cases where echocardiography image quality is not adequate. Nevertheless, patients with reduced heart function on echocardiography might benefit from early assessment of inflammatory or fibrotic changes due to CTRCD using cardiac MRI.

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Abbreviations

Cine SSFP:

Cine Steady-State Free Precession

CTRCD:

Cancer therapeutics-related cardiac dysfunction

ECV:

Extrazelluläres Volumen

EF:

Ejektionsfraktion

Kardiale MRT:

Kardiale Magnetresonanztomographie

LGE:

Late-Gadolinium-Enhancement

MAP:

Mitogen-activated protein

VEGF:

Vascular endothelial growth factor

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Authors and Affiliations

  1. Zentrum für Radiologie und Endoskopie, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland

    Jennifer Erley &  Enver Tahir

  2. Zentrum für Onkologie, II. Medizinische Klinik und Poliklinik (Onkologie, Hämatologie, Knochenmarktransplantation mit Abteilung für Pneumologie), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Antonia Beitzen-Heineke

  3. Zentrum für Experimentelle Medizin, Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Antonia Beitzen-Heineke

Authors
  1. Jennifer Erley
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  2. Antonia Beitzen-Heineke
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  3. Enver Tahir
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Corresponding author

Correspondence to Enver Tahir.

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Interessenkonflikt

J. Erley, A. Beitzen-Heineke und E. Tahir geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Erley, J., Beitzen-Heineke, A. & Tahir, E. Kardioonkologie – was leistet die MRT?. Radiologie 62, 941–946 (2022). https://doi.org/10.1007/s00117-022-01055-x

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  • DOI: https://doi.org/10.1007/s00117-022-01055-x

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