Background: Cardiac magnetic resonance imaging (MRI) is emerging as an important diagnostic modality in the management of cardiovascular-related dysfunction in oncological diseases. Advances in imaging techniques have enhanced the detection and evaluation of cardiac masses; meanwhile, innovative applications have created a growing role for cardiac MRI for the management of cardiotoxicity caused by cancer therapies. Methods: An overview is provided of the clinical indications and technical considerations of cardiac MRI. Its role in the evaluation of cardiac masses and cardiac function is reviewed, and novel sequences are discussed that are giving rise to future directions in cardio-oncology research. A review of the literature was also performed, focusing on cardiac MRI findings associated with cardiac dysfunction related to cancer treatment.
Results: Cardiac MRI can be used to differentiate benign and malignant primary cardiac tumors, metastatic disease, and pseudotumors with high spatial and temporal resolution. Cardiac MRI can also be used to detect the early and long-term effects of cardiotoxicity related to cancer therapy. This is accomplished through a multiparametric approach that uses conventional bright blood, dark blood, and postcontrast sequences while also considering the applicability of newer T1 and T2 mapping sequences and other emerging techniques. Conclusions: Cardio-oncology programs have an expanding presence in the multidisciplinary approach of cancer care. Consequently, knowledge of cardiac MRI and its potential applications is critical to the success of contemporary cancer diagnostics and cancer management.
Cardiac magnetic resonance imaging (MRI) is emerging as an important diagnostic modality in the management of cardiovascular-related dysfunction in oncological diseases. With survival rates becoming longer in patients with cancer and in those with chronic cardiovascular disease, new strategies are being developed to manage the increasing overlap between these groups of patients.1 Cardio-oncology programs have an expanding presence in the multidisciplinary approach to cancer care. Thus, knowledge of cardiac MRI and its potential applications is important to the success of contemporary oncological diagnosis and management.
Expert consensus published in 2010 on cardiac MRI includes several important indications related to oncological evaluation and monitoring.2 Cardiac MRI may be used to characterize tissue within cardiac masses and may aid in the early differentiation between cardiac pseudotumors, benign or malignant cardiac tumors, and thrombi.2-4 Furthermore, cardiac MRI can help the health care professional characterize extracardiac structures, including pericardial masses, and delineate the physiological sequelae of tissue involvement such as pericardial constriction.2
In patients with heart failure or nonischemic heart disease, cardiac MRI is indicated to quantitatively evaluate chamber size, ventricular mass and morphology, wall motion abnormalities, and systolic and diastolic function.2,5 These evaluations are useful in patients with cardiomyopathies related to cardiotoxicity or infiltrative diseases, including amyloidosis or sarcoidosis.2 Patients receiving chemotherapy who frequently receive blood transfusions are at risk for iron overload, which may also be evaluated with cardiac MRI.6 In patients with cancer and comorbid, chronic cardiovascular conditions, such as coronary artery disease and ischemic heart disease, cardiac MRI may be used to assess for myocardial viability, necrosis, and scar tissue, and can be used to identify subendocardial ischemic processes.2 Structural abnormalities, including coronary artery anomalies and valvular disorders, can also be evaluated. In pediatric patients with cancer, cardiac MRI may be an important adjunct for assessing congenital heart disease without exposing these children to ionizing radiation.