Top

25-09-2024 | Positron Emission Tomography | Review

Clinical Applications and Advancements of Positron Emission Tomography/Computed Tomography in Cardio-Oncology: A Comprehensive Literature Review and Emerging Perspectives

Authors: Ayman Battisha, Chitsimran Mann, Rutu Raval, Asuwin Anandaram, Brijesh Patel

Abstract

Purpose of Review

Recent advancements in molecular biology, biotechnology, chemistry/radiochemistry, artificial intelligence, and imaging techniques have significantly propelled the field of cardiovascular molecular imaging. This review aims to provide a comprehensive overview of the current state of cardiovascular positron emission tomography (PET) imaging and cardiac computed tomography (CT), exploring their roles in elucidating molecular and cellular processes, enabling early disease detection, and guiding novel therapeutic interventions for cardiovascular conditions.

Recent Findings

Cardiovascular PET imaging strives to uncover molecular and cellular events preceding visible anatomical manifestations or physiological changes. Meanwhile, cardiac CT has evolved into a multifaceted modality, offering insights into both anatomy and function. Utilizing advanced CT technologies allows for a thorough evaluation, encompassing fractional flow reserve, perfusion imaging, pericoronary adipose tissue attenuation, atherosclerotic plaque characterization, cardiomyopathies, structural cardiac abnormalities, and congenital heart anomalies. The emergence of hybrid imaging, combining PET and CT, presents innovative prospects in cardiology. This approach enables the simultaneous assessment of cardiac perfusion and coronary anatomy in a singular scan, providing complementary insights relevant to potential coronary artery disease. Despite the substantial potential impact, operational familiarity with this hybrid tool remains limited, and its integration into routine clinical practice warrants further exploration.

Summary

In summary, the review underscores the transformative impact of recent technological advancements on cardiovascular molecular imaging. The integration of PET and CT, along with their individual capabilities, holds promise for early disease detection and informed clinical decision-making. While acknowledging the potential of hybrid imaging, it emphasizes the need for increased operational familiarity and continued exploration to facilitate its seamless integration into routine clinical practice. The insights gained from this review contribute to the ongoing dialogue in the field, offering a foundation for future research and advancements in cardiovascular imaging.

Di Carli MF, Hachamovitch R. New technology for noninvasive evaluation of coronary artery disease. Circulation. Mar 20. 2007;115(11):1464–80. https://doi.org/10.1161/circulationaha.106.629808

Carli MFD, Murthy VL. Cardiac PET/CT for the evaluation of known or suspected coronary artery disease. Radiographics. 2011;31(5):1239–54. https://doi.org/10.1148/rg.315115056.CrossRefPubMedPubMedCentral

Knaapen P, de Haan S, Hoekstra OS, et al. Cardiac PET-CT: advanced hybrid imaging for the detection of coronary artery disease. Neth Heart J Feb. 2010;18(2):90–8. https://doi.org/10.1007/bf03091744.CrossRef

Alberts I, Sari H, Mingels C, et al. Long-axial field-of-view PET/CT: perspectives and review of a revolutionary development in nuclear medicine based on clinical experience in over 7000 patients. Cancer Imaging. 2023;23(1). https://doi.org/10.1186/s40644-023-00540-3.

Nakazato R, Berman DS, Alexanderson E, Slomka P. Myocardial perfusion imaging with PET. Imaging Med. Feb 2013;1(1):35–46. https://doi.org/10.2217/iim.13.1.CrossRef

Schenker MP, Dorbala S, Hong EC et al. Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: a combined positron emission tomography/computed tomography study. Circulation. Apr 1. 2008;117(13):1693–700. https://doi.org/10.1161/circulationaha.107.717512

van Werkhoven JM, Schuijf JD, Gaemperli O, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol Feb. 2009;17(7):623–32. https://doi.org/10.1016/j.jacc.2008.10.043.CrossRef

Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med Feb. 2007;22(8):830–40. https://doi.org/10.1056/NEJMra061889.CrossRef

Dorbala S, Di Carli MF, Cardiac. PET perfusion: prognosis, risk stratification, and clinical management. Semin Nucl Med. Sep 2014;44(5):344–57. https://doi.org/10.1053/j.semnuclmed.2014.05.003.

10.

Gimelli A, Liga R, Duce V, Kusch A, Clemente A, Marzullo P. Accuracy of myocardial perfusion imaging in detecting multivessel coronary artery disease: a cardiac CZT study. J Nucl Cardiol Apr. 2017;24(2):687–95. https://doi.org/10.1007/s12350-015-0360-8.CrossRef

11.

Kaufmann PA, Di Carli MF. Hybrid SPECT/CT and PET/CT imaging: the next step in noninvasive cardiac imaging. Semin Nucl Med. Sep 2009;39(5):341–7. https://doi.org/10.1053/j.semnuclmed.2009.03.007.

12.

Fahim Ul H, Cook GJ. PET/CT in oncology. Clin Med (Lond) Aug. 2012;12(4):368–72. https://doi.org/10.7861/clinmedicine.12-4-368.CrossRef

13.

Slart RHJA, Glaudemans AWJM, Gheysens O, et al. Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM. Eur J Nucl Med Mol Imaging. 2021;48(4):1016–39. https://doi.org/10.1007/s00259-020-05066-5.CrossRefPubMed

14.

Battisha A, Sawalha K, Obeidat Y, Patel B. Role of cardiac biomarkers in monitoring cardiotoxicity in Chemotherapy patients. Crit Pathw Cardiol. 2023;22(3):83–7. https://doi.org/10.1097/hpc.0000000000000314.CrossRefPubMed

15.

Kelly JM, Babich JW. PET Tracers for Imaging Cardiac function in Cardio-Oncology. Curr Cardiol Rep Mar. 2022;24(3):247–60. https://doi.org/10.1007/s11886-022-01641-4.CrossRef

16.

Becker MMC, Arruda GFA, Berenguer DRF, Buril RO, Cardinale D, Brandão SCS. Anthracycline cardiotoxicity: current methods of diagnosis and possible role of (18)F-FDG PET/CT as a new biomarker. Cardiooncology Mar. 2023;27(1):17. https://doi.org/10.1186/s40959-023-00161-6.CrossRef

17.

Di Carli MF, Murthy VL. Cardiac PET/CT for the evaluation of known or suspected coronary artery disease. Radiographics Sep-Oct. 2011;31(5):1239–54. https://doi.org/10.1148/rg.315115056.CrossRef

18.

Griffeth LK. Use of PET/CT scanning in cancer patients: technical and practical considerations. Proc (Bayl Univ Med Cent) Oct. 2005;18(4):321–30. https://doi.org/10.1080/08998280.2005.11928089.CrossRef

19.

Saif MW, Tzannou I, Makrilia N, Syrigos K. Role and cost effectiveness of PET/CT in management of patients with cancer. Yale J Biol Med Jun. 2010;83(2):53–65.

20.

Taqueti VR, Di Carli MF. Coronary microvascular disease pathogenic mechanisms and therapeutic options: JACC State-of-the-art review. J Am Coll Cardiol Nov. 2018;27(21):2625–41. https://doi.org/10.1016/j.jacc.2018.09.042.CrossRef

21.

Danad I, Raijmakers PG, Driessen RS, et al. Comparison of coronary CT angiography, SPECT, PET, and Hybrid Imaging for diagnosis of ischemic heart Disease determined by fractional Flow Reserve. JAMA Cardiol. 2017;2(10):1100–7. https://doi.org/10.1001/jamacardio.2017.2471.CrossRefPubMedPubMedCentral

22.

Schindler TH, Fearon WF, Pelletier-Galarneau M, et al. Myocardial perfusion PET for the detection and reporting of coronary microvascular dysfunction: a JACC: Cardiovascular Imaging Expert Panel Statement. JACC Cardiovasc Imaging Apr. 2023;16(4):536–48. https://doi.org/10.1016/j.jcmg.2022.12.015.CrossRef

23.

Ziadi MC. Myocardial flow reserve (MFR) with positron emission tomography (PET)/computed tomography (CT): clinical impact in diagnosis and prognosis. Cardiovasc Diagn Ther Apr. 2017;7(2):206–18. https://doi.org/10.21037/cdt.2017.04.10.CrossRef

24.

Quryshi N, Norwood Toro LE, Ait-Aissa K, Kong A, Beyer AM. Chemotherapeutic-Induced Cardiovascular Dysfunction: physiological effects, early detection-the role of telomerase to counteract mitochondrial defects and oxidative stress. Int J Mol Sci Mar. 2018;10(3). https://doi.org/10.3390/ijms19030797.

25.

Gould KL, Johnson NP, Narula J. Microvascular dysfunction or diffuse epicardial CAD with normal stress vasodilation. JACC Cardiovasc Imaging Apr. 2023;16(4):549–52. https://doi.org/10.1016/j.jcmg.2022.10.029.CrossRef

26.

Rajai N, Ahmad A, Toya T, et al. Coronary microvascular dysfunction is an independent predictor of developing cancer in patients with non-obstructive coronary artery disease. Eur J Prev Cardiol Feb. 2023;14(3):209–16. https://doi.org/10.1093/eurjpc/zwac184.CrossRef

27.

Sara JD, Kaur J, Khodadadi R, et al. 5-fluorouracil and cardiotoxicity: a review. Ther Adv Med Oncol. 2018;10. https://doi.org/10.1177/1758835918780140.

28.

Polk A, Vaage-Nilsen M, Vistisen K, Nielsen DL. Cardiotoxicity in cancer patients treated with 5-fluorouracil or capecitabine: a systematic review of incidence, manifestations and predisposing factors. Cancer Treat Rev Dec. 2013;39(8):974–84. https://doi.org/10.1016/j.ctrv.2013.03.005.CrossRef

29.

Polk A, Shahmarvand N, Vistisen K, et al. Incidence and risk factors for capecitabine-induced symptomatic cardiotoxicity: a retrospective study of 452 consecutive patients with metastatic breast cancer. BMJ Open Oct. 2016;19(10):e012798. https://doi.org/10.1136/bmjopen-2016-012798.CrossRef

30.

Chong JH, Ghosh AK. May. Coronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions. Interv Cardiol. 2019;14(2):89–94. https://doi.org/10.15420/icr.2019.12

31.

Moudgil R, Yeh ET. Mechanisms of cardiotoxicity of Cancer Chemotherapeutic agents: Cardiomyopathy and Beyond. Can J Cardiol Jul. 2016;32(7):863–e8705. https://doi.org/10.1016/j.cjca.2016.01.027.CrossRef

32.

Cameron AC, Touyz RM, Lang NN. Vascular complications of Cancer Chemotherapy. Can J Cardiol Jul. 2016;32(7):852–62. https://doi.org/10.1016/j.cjca.2015.12.023.CrossRef

33.

Herrmann J. Vascular toxic effects of cancer therapies. Nature Reviews Cardiology. 2020/08/01 2020;17(8):503–522. https://doi.org/10.1038/s41569-020-0347-2.

34.

Herrmann J. Cardiovascular Toxicity with cisplatin in patients with testicular Cancer: looking for something heavier than Heavy Metal. JACC CardioOncol Sep. 2020;2(3):456–9. https://doi.org/10.1016/j.jaccao.2020.07.007.CrossRef

35.

Chung R, Tyebally S, Chen D, et al. Hypertensive cardiotoxicity in Cancer Treatment-systematic analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies-Epidemiology, incidence, and pathophysiology. J Clin Med Oct. 2020;18(10). https://doi.org/10.3390/jcm9103346.

36.

van Dorst DCH, Dobbin SJH, Neves KB, et al. Hypertension and Prohypertensive Antineoplastic therapies in Cancer patients. Circ Res Apr. 2021;2(7):1040–61. https://doi.org/10.1161/circresaha.121.318051.CrossRef

37.

Kounis NG, Soufras GD, Tsigkas G, Hahalis G. Adverse cardiac events to monoclonal antibodies used for cancer therapy: the risk of Kounis syndrome. Oncoimmunology. 2014;3:e27987. https://doi.org/10.4161/onci.27987.CrossRefPubMedPubMedCentral

38.

Qi WX, Fu S, Zhang Q, Guo XM. Bevacizumab increases the risk of severe congestive heart failure in cancer patients: an up-to-date meta-analysis with a focus on different subgroups. Clin Drug Investig Oct. 2014;34(10):681–90. https://doi.org/10.1007/s40261-014-0222-1.CrossRef

39.

Gürdoğan M, Demir M, Yalta K, Gülertop Y. Cancer Therapy-related pulmonary hypertension: a review of mechanisms and implications for clinical practice. Anatol J Cardiol Jun. 2023;27(6):299–307. https://doi.org/10.14744/AnatolJCardiol.2023.3013.CrossRef

40.

Shalata W, Abu-Salman A, Steckbeck R, Mathew Jacob B, Massalha I, Yakobson A. Cardiac Toxicity Associated with Immune Checkpoint inhibitors: a systematic review. Cancers (Basel) Oct. 2021;18(20). https://doi.org/10.3390/cancers13205218.

41.

Ganatra S, Neilan TG. Immune Checkpoint inhibitor-Associated Myocarditis. Oncologist Aug. 2018;23(8):879–86. https://doi.org/10.1634/theoncologist.20180130.CrossRef

42.

Murthy VL, Bateman TM, Beanlands RS, et al. Clinical quantification of myocardial blood Flow using PET: joint position paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Med Feb. 2018;59(2):273–93. https://doi.org/10.2967/jnumed.117.201368.CrossRef

43.

Del Buono Marco G, Montone Rocco A, Camilli M et al. Coronary Microvascular Dysfunction Across the Spectrum of Cardiovascular Diseases. Journal of the American College of Cardiology. 2021/09/28 2021;78(13):1352–1371. https://doi.org/10.1016/j.jacc.2021.07.042

44.

Kelshiker MA, Seligman H, Howard JP, et al. Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis. Eur Heart J Apr. 2022;19(16):1582–93. https://doi.org/10.1093/eurheartj/ehab775.CrossRef

45.

Nakazato R, Heo R, Leipsic J, Min JK. CFR and FFR assessment with PET and CTA: strengths and limitations. Curr Cardiol Rep May. 2014;16(5):484. https://doi.org/10.1007/s11886-014-0484-5.CrossRef

46.

Bhandiwad AR, Valenta I, Jain S, Schindler TH. PET-determined prevalence of coronary microvascular dysfunction and different types in a cardio-metabolic risk population. Int J Cardiol Heart Vasc Jun. 2023;46:101206. https://doi.org/10.1016/j.ijcha.2023.101206.CrossRef

47.

Vancheri F, Longo G, Vancheri S, Henein M. Coronary microvascular dysfunction. J Clin Med Sep. 2020;6(9). https://doi.org/10.3390/jcm9092880.

48.

Reddy AS, Uceda DE, Al Najafi M, Dey AK, Mehta NN. PET scan with Fludeoxyglucose/Computed tomography in low-Grade vascular inflammation. PET Clin Apr. 2020;15(2):207–13. https://doi.org/10.1016/j.cpet.2019.11.009.CrossRef

49.

Soehnlein O, Libby P. Targeting inflammation in atherosclerosis — from experimental insights to the clinic. Nature Reviews Drug Discovery. 2021/08/01 2021;20(8):589–610. doi:10.1038/s41573-021-00198-1.

50.

Joseph P, Tawakol A. Imaging atherosclerosis with positron emission tomography. Eur Heart J. 2016;37(39):2974–80. https://doi.org/10.1093/eurheartj/ehw147.CrossRefPubMed

51.

Tawakol A, Migrino RQ, Bashian GG, et al. In vivo 18F-fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflammation in patients. J Am Coll Cardiol Nov. 2006;7(9):1818–24. https://doi.org/10.1016/j.jacc.2006.05.076.CrossRef

52.

Truijers M, Kurvers HA, Bredie SJ, Oyen WJ, Blankensteijn JD. In vivo imaging of abdominal aortic aneurysms: increased FDG uptake suggests inflammation in the aneurysm wall. J Endovasc Ther Aug. 2008;15(4):462–7. https://doi.org/10.1583/08-2447.1.CrossRef

53.

van der Geest KSM, Treglia G, Glaudemans A, et al. Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging Nov. 2021;48(12):3886–902. https://doi.org/10.1007/s00259-021-05362-8.CrossRef

54.

Lee DH, Lee SJ, Lee DJ, et al. Carotid artery FDG uptake may serve as a Biomarker for Cardiovascular Risk Stratification in asymptomatic adults. Nucl Med Mol Imaging Sep. 2014;48(3):196–202. https://doi.org/10.1007/s13139-014-0277-1.CrossRef

55.

Figueroa AL, Abdelbaky A, Truong QA, et al. Measurement of arterial activity on routine FDG PET/CT images improves prediction of risk of future CV events. JACC Cardiovasc Imaging Dec. 2013;6(12):1250–9. https://doi.org/10.1016/j.jcmg.2013.08.006.CrossRef

56.

Miller RJH, Singh A, Dey D, Slomka P. Artificial Intelligence and Cardiac PET/Computed Tomography Imaging. PET Clin Jan. 2022;17(1):85–94. https://doi.org/10.1016/j.cpet.2021.06.011.CrossRef

57.

Slomka P. Future of nuclear cardiology is bright: Promise of cardiac PET/CT and artificial intelligence. Journal of Nuclear Cardiology. 2022/04/01 2022;29(2):389–391. https://doi.org/10.1007/s12350-022-02942-5.

58.

Popescu C, Laudicella R, Baldari S, et al. PET-based artificial intelligence applications in cardiac nuclear medicine. Swiss Med Wkly. 2022;152:w30123.CrossRefPubMed

59.

Liu K, Werner T, Revheim M-E, Alavi A. <strong > potential of Artificial Intelligence Cardiovascular PET imaging </strong >. J Nucl Med. 2022;63(supplement 2):2753–2753.

60.

Kwiecinski J, Tzolos E, Meah MN, et al. Machine learning with (18)F-Sodium fluoride PET and quantitative plaque analysis on CT angiography for the future risk of myocardial infarction. J Nucl Med Jan. 2022;63(1):158–65. https://doi.org/10.2967/jnumed.121.262283.CrossRef

61.

Shaw LJ, Blankstein R. Next step for hybrid PET-CT imaging: automation of CAC scores. JACC Cardiovasc Imaging May. 2023;16(5):688–90. https://doi.org/10.1016/j.jcmg.2023.02.021.CrossRef

62.

van Velzen SGM, Lessmann N, Velthuis BK, et al. Deep Learning for Automatic Calcium Scoring in CT: validation using multiple cardiac CT and chest CT protocols. Radiol Apr. 2020;295(1):66–79. https://doi.org/10.1148/radiol.2020191621.CrossRef

63.

Lessmann N, van Ginneken B, Zreik M, et al. Automatic calcium scoring in low-dose chest CT using deep neural networks with dilated convolutions. IEEE Trans Med Imaging Feb. 2018;37(2):615–25. https://doi.org/10.1109/tmi.2017.2769839.CrossRef

64.

Rana JS, Rozanski A, Berman DS. Combination of myocardial perfusion imaging and coronary artery calcium scanning: potential synergies for improving risk assessment in subjects with suspected coronary artery disease. Curr Atheroscler Rep Oct. 2011;13(5):381–9. https://doi.org/10.1007/s11883-011-0192-1.CrossRef

65.

Išgum I, de Vos BD, Wolterink JM, et al. Automatic determination of cardiovascular risk by CT attenuation correction maps in Rb–82 PET/CT. J Nucl Cardiol Dec. 2018;25(6):2133–42. https://doi.org/10.1007/s12350-017-0866-3.CrossRef

66.

Pieszko K, Shanbhag A, Killekar A, et al. Deep learning of coronary calcium scores from PET/CT attenuation maps accurately predicts adverse Cardiovascular events. JACC Cardiovasc Imaging May. 2023;16(5):675–87. https://doi.org/10.1016/j.jcmg.2022.06.006.CrossRef

67.

Commandeur F, Goeller M, Razipour A, et al. Fully automated CT quantification of Epicardial Adipose tissue by Deep Learning: a Multicenter Study. Radiol Artif Intell Nov. 2019;27(6):e190045. https://doi.org/10.1148/ryai.2019190045.CrossRef

68.

Šprem J, de Vos BD, Lessmann N, et al. Coronary calcium scoring with partial volume correction in anthropomorphic thorax phantom and screening chest CT images. PLoS ONE. 2018;13(12):e0209318. https://doi.org/10.1371/journal.pone.0209318.CrossRefPubMedPubMedCentral

Title: Clinical Applications and Advancements of Positron Emission Tomography/Computed Tomography in Cardio-Oncology: A Comprehensive Literature Review and Emerging Perspectives
Authors: Ayman Battisha
Chitsimran Mann
Rutu Raval
Asuwin Anandaram
Brijesh Patel
Publication date: 25-09-2024
Publisher: Springer US
Keywords: Positron Emission Tomography
Computed Tomography
Computed Tomography
Artificial Intelligence
Published in: Current Oncology Reports
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI: https://doi.org/10.1007/s11912-024-01598-3

2024 ESMO Congress

Add-on Ra223 could be a new first-line option in mCRPC

17-09-2024
Prostate Cancer
News

Adding radium-223 to first-line enzalutamide significantly improves the survival of patients with bone metastatic castration-resistant prostate cancer.

19-09-2024
Diagnostics in Oncology
News

No OS benefit of adding preoperative CRT in gastric cancer

17-09-2024
Gastric Cancer
News

T-DXd supported for breast cancer with brain metastases

17-09-2024
Breast Cancer
News

» View more highlights on the ESMO 2024 hub page

Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

Webinar | 01-10-2024 | 12:30 (CEST)

Live event concluded

In this webinar, Professor Martin Dreyling and an esteemed, international panel of CAR-T experts discuss the latest data on the safety, efficacy, and clinical impact of CAR T-cell therapies in the treatment of r/r DLBCL and r/r FL.

Please note, this webinar is not intended for healthcare professionals based in the US and UK.

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Clinical Applications and Advancements of Positron Emission Tomography/Computed Tomography in Cardio-Oncology: A Comprehensive Literature Review and Emerging Perspectives

Abstract

Purpose of Review

Recent Findings

Summary

2024 ESMO Congress

Add-on Ra223 could be a new first-line option in mCRPC

AI model can predict tumor mutations

No OS benefit of adding preoperative CRT in gastric cancer

T-DXd supported for breast cancer with brain metastases

» View more highlights on the ESMO 2024 hub page

Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

Live event concluded

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

2024 ESMO Congress

Add-on Ra223 could be a new first-line option in mCRPC

AI model can predict tumor mutations

No OS benefit of adding preoperative CRT in gastric cancer

T-DXd supported for breast cancer with brain metastases

» View more highlights on the ESMO 2024 hub page

Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

Live event concluded