Cardio Oncology
Jessica Artico, MD
Clinical Research Fellow
St Bartholomew's Hospital, England, United Kingdom
Jessica Artico, MD
Clinical Research Fellow
St Bartholomew's Hospital, England, United Kingdom
Aderonke T. Abiodun, MBChB
Clinical Research Fellow
University College London, United Kingdom
Hibba Kurdi, MD, BSc
Cardiology Fellow
Barts Health NHS Trust, London, UK
London, United Kingdom
Hunain Shiwani, MD
Clinical Research Fellow
University College London and Barts Heart Centre, United Kingdom
Rhodri Davies, MD, PhD
Associate clinical professor
University College London
London, Wales, United Kingdom
Daniel Chen, MD
Cardiologist
University College London Hospitals
LONDON, England, United Kingdom
Iain Pierce, PhD
Scientist
Barts Heart Centre at St Bartholomew's Hospital, United Kingdom
.jpg "Camilla Torlasco, MD PhD photo")
Camilla Torlasco, MD PhD
Dr
IRCCS Istituto Auxologico Italiano, Milan, United Kingdom
Kelvin Chow, PhD
Staff Scientist
Siemens Healthineers
Chicago, Illinois, United States
Hui Xue, PhD
Director, Imaging AI Program
National Institutes of Health
Bethesda, Maryland, United States
Peter Kellman, PhD
Senior Scientist
National Institutes of Health, Maryland, United States
Thomas A. Treibel, MD, PhD
Consultant Cardiologist
University College London, England, United Kingdom
James C. Moon, MD
Clinical Director, Imaging
Barts Heart Centre and UCL
London, England, United Kingdom
Charlotte Manisty
Consultant Cardiologist
University College London and Barts Heart Centre
London, England, United Kingdom
Screening for cancer treatment related cardiac dysfunction (CTRCD) is of growing importance, with increasing focus on measurement precision to ensure timely and accurate diagnosis whilst preventing inappropriate cessation of cancer treatment. Cardiovascular Magnetic Resonance (CMR) has superior precision for serial measurement of left ventricular ejection fraction (LVEF) and provides additional insight with strain and tissue characterization. Currently, scan duration, cost, and availability limit wider adoption, however rapid CMR targeted protocols coupled with in-line analysis provide an opportunity for adoption into CTRCD screening pathways.
Methods:
We consecutively recruited cancer patients or survivors undergoing CMR for clinical screening for CTRCD. Patients with known cardiovascular disease were excluded. The RAPID-Cardiotoxicity protocol included localizers, axial bright blood anatomical (bSSFP) stack, bSSFP cine imaging (3 long axis and short axis stack), and prototype free-breathing combined T1 and T2 multiparametric mapping (mSASHA)1 in 3 short axis slices (Figure 1). Automated analysis of LV volumes and longitudinal function, and global and segmental T1 and T2 values was performed inline using previously validated algorithms, plotted using age and sex-specific reference ranges where available2,3.
Scan durations were compared to a contemporaneous cohort of patients undergoing CMR for cardiotoxicity using a standard non-contrast CMR protocol with MOLLI T1 and T2p-bSSFP T2 maps, analysed using commercial software (cvi42, Circle Cardiovascular Imaging).
Results:
32 patients were scanned using RAPID-Cardiotoxicity protocol with inline analysis and compared with 32 patients undergoing cardiotoxicity screening using standard protocols. Using the RAPID-Cardiotoxicity protocol, mean scan duration was 9.8 (range 5-14) minutes, compared to 14.2 (range 8-18) minutes (p< 0.001) for the standard CTRCD protocol. Parametric mapping with mSASHA added 2.3 minutes (total 12.1 minutes), whilst standard breath-hold T1 and T2 mapping increased average scan length by 4.6 minutes.
The inline automated left ventricular segmentation, longitudinal and mapping analysis provided instantaneous on-scanner results plotted against reference ranges (Figure 1), with manual adjustment required in zero cases.
Off-line image segmentation and analysis of LV function and GLS using commercial software required 6.8 (range 4 to 10) minutes of operator time, while mapping required 3.0 (range 2 to 6) minutes.
Total acquisition and analysis time was reduced from an average of 26.7 (17.0-35.0) minutes using conventional protocols and software to 12.9 (7.6-17.8) minutes using RAPID-Cardiotoxicity plus inline AI analysis; average 51.7% reduction.
Conclusion:
Rapid CMR for cardiotoxicity surveillance during cancer therapy delivers gold-standard measurement precision within 15-minute slots. Combining RAPID-Cardiotoxicity with automated inline AI analysis cuts total pathway time (first image to report) by over half.