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Research ArticleImaging

PET/MRI Assessment of Acute Cardiac Inflammation 1 Month After Left-Sided Breast Cancer Radiation Therapy

Oi Wai Chau, Ali Islam, Michael Lock, Edward Yu, Robert Dinniwell, Brian Yaremko, Muriel Brackstone, William Pavlosky, John Butler, Heather Biernaski, Chantelle Graf, Gerald Wisenberg, Frank S. Prato and Stewart Gaede
Journal of Nuclear Medicine Technology June 2023, 51 (2) 133-139; DOI: https://doi.org/10.2967/jnmt.122.264960
Oi Wai Chau
1London Regional Cancer Program, London, Ontario, Canada;
2Western University, London, Ontario, Canada;
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Ali Islam
2Western University, London, Ontario, Canada;
3Lawson Health Research Institute, London, Ontario, Canada; and
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Michael Lock
1London Regional Cancer Program, London, Ontario, Canada;
2Western University, London, Ontario, Canada;
4London Health Sciences Centre, London, Ontario, Canada
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Edward Yu
1London Regional Cancer Program, London, Ontario, Canada;
2Western University, London, Ontario, Canada;
4London Health Sciences Centre, London, Ontario, Canada
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Robert Dinniwell
1London Regional Cancer Program, London, Ontario, Canada;
2Western University, London, Ontario, Canada;
4London Health Sciences Centre, London, Ontario, Canada
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Brian Yaremko
1London Regional Cancer Program, London, Ontario, Canada;
2Western University, London, Ontario, Canada;
4London Health Sciences Centre, London, Ontario, Canada
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Muriel Brackstone
2Western University, London, Ontario, Canada;
3Lawson Health Research Institute, London, Ontario, Canada; and
4London Health Sciences Centre, London, Ontario, Canada
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William Pavlosky
3Lawson Health Research Institute, London, Ontario, Canada; and
4London Health Sciences Centre, London, Ontario, Canada
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John Butler
3Lawson Health Research Institute, London, Ontario, Canada; and
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Heather Biernaski
3Lawson Health Research Institute, London, Ontario, Canada; and
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Chantelle Graf
3Lawson Health Research Institute, London, Ontario, Canada; and
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Gerald Wisenberg
2Western University, London, Ontario, Canada;
3Lawson Health Research Institute, London, Ontario, Canada; and
4London Health Sciences Centre, London, Ontario, Canada
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Frank S. Prato
2Western University, London, Ontario, Canada;
3Lawson Health Research Institute, London, Ontario, Canada; and
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Stewart Gaede
1London Regional Cancer Program, London, Ontario, Canada;
2Western University, London, Ontario, Canada;
3Lawson Health Research Institute, London, Ontario, Canada; and
4London Health Sciences Centre, London, Ontario, Canada
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  • FIGURE 1.
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    FIGURE 1.

    Overview of timeline and PET/MRI protocol. GD-DO3A-butrol = gadobutrol; MOLLI = modified look-locker; MRAC = MRI-based attenuation correction.

  • FIGURE 2.
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    FIGURE 2.

    18F-FDG PET SUVmean of myocardium of 15 patients at baseline and 1-mo follow-up. Uptake values for entire myocardium were categorized by regions supplied by LAD, left circumflex coronary artery, and right coronary artery. Mean value is indicated with +, and median is indicated as median bar. *Significant difference at 1-mo follow-up. LCX = left circumflex coronary artery; RC = right coronary artery; SUVbw = SUVmean based on body weight.

  • FIGURE 3.
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    FIGURE 3.

    Mean cardiac functional parameters including LV end-diastolic volume, SV, and LVEF for 15 patients before and 1 mo after RT. Significant reduction at 1 mo after RT was shown in SV. Mean value is indicated with +, and median is indicated as median bar. *Significant difference at 1-mo follow-up. EDV = end-diastolic volume; EF = ejection fraction.

  • FIGURE 4.
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    FIGURE 4.

    Mean ECVs before and 1 mo after RT. Significant increases in ECVs in apical and basal slices were observed at 1-mo follow-up. Mean value is indicated with +, and median is indicated as median bar. *Significant difference at 1-mo follow-up.

  • FIGURE 5.
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    FIGURE 5.

    Presented are mean blood work measurements of hs-TnT, hs-CRP and erythrocyte sedimentation rate before and 1 mo after RT. Mean value is indicated with +, and median is indicated as median bar. ESR = erythrocyte sedimentation rate.

Tables

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    TABLE 1.

    Demographics and Radiation Dose Metrics

    ParameterData
    Mean age (y)60 (range, 38–79)
    Staging (n)
     TCIS3
     T18 (1 recurrence)
     T23
     T31
    RT (n)
     Free-breathing RT4 (27%)
     Tomotherapy2
     IMRT1
     VMAT1
     DIBH IMRT11 (73%)
    Prescription dose (n)
     42.5 Gy in 16 fractions14
     Boost of 10 Gy in 5 fractions7
     48 Gy in 16 fractions1
    Mean heart dose (Gy)1.79
    Mean LV dose (Gy)2.07
    Mean LAD dose (Gy)2.78
    Mean heart V5Gy9.46%
    Mean maximum heart dose (Gy)19.31
    Mean maximum LAD dose (Gy)8.41
    Adjuvant chemotherapy (n)
     Yes5 (33%)
     Herceptin4
     No10 (67%)
    • DIBH = deep inspiration breath-hold; IMRT = intensity-modulated radiation therapy; VMAT = volumetric-modulated arc therapy.

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    TABLE 2.

    Differences in Parameters Between Baseline and 1-Month Follow-up

    ParameterBaseline1-mo follow-upDifference
    18F-FDG PET SUVmean
     Left circumflex1.521.626%
     LAD*1.471.6110%
     Right coronary1.611.674%
    LV function
     EDV (mL)123115.92−6%
     SV* (mL)79.2774−7%
     EF (%)65.464.25−2%
    ECVs
     Apex*0.2890.3076%
     Mid0.2710.2753%
     Base*0.2680.2795%
    Blood work
     hs-TnT (ng/L)107.92−21%
     hs-CRP (mg/L)3.392.53−25%
     Erythrocyte sedimentation rate (mm/h)12.6411.42−10%
    • ↵* Significant difference.

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    TABLE 3.

    Correlation and Significance of Changes in 18F-FDG PET SUV

    ParameterMean doseHeart V5GyMaximum dose
    HeartLVLADHeartLAD
    18F-FDG LAD
     r0.120.04−0.230.170.07−0.24
     P0.740.910.530.630.850.51
    SV
     r0.250.320.220.210.140.37
     P0.460.340.520.530.690.27
    ECV apex
     r0.340.380.190.300.360.33
     P0.280.220.550.350.260.30
    ECV base
     r0.440.440.570.410.410.55
     P0.170.180.070.210.210.08
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Journal of Nuclear Medicine Technology: 51 (2)
Journal of Nuclear Medicine Technology
Vol. 51, Issue 2
June 1, 2023
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PET/MRI Assessment of Acute Cardiac Inflammation 1 Month After Left-Sided Breast Cancer Radiation Therapy
Oi Wai Chau, Ali Islam, Michael Lock, Edward Yu, Robert Dinniwell, Brian Yaremko, Muriel Brackstone, William Pavlosky, John Butler, Heather Biernaski, Chantelle Graf, Gerald Wisenberg, Frank S. Prato, Stewart Gaede
Journal of Nuclear Medicine Technology Jun 2023, 51 (2) 133-139; DOI: 10.2967/jnmt.122.264960

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PET/MRI Assessment of Acute Cardiac Inflammation 1 Month After Left-Sided Breast Cancer Radiation Therapy
Oi Wai Chau, Ali Islam, Michael Lock, Edward Yu, Robert Dinniwell, Brian Yaremko, Muriel Brackstone, William Pavlosky, John Butler, Heather Biernaski, Chantelle Graf, Gerald Wisenberg, Frank S. Prato, Stewart Gaede
Journal of Nuclear Medicine Technology Jun 2023, 51 (2) 133-139; DOI: 10.2967/jnmt.122.264960
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