Extracellular Volume from MRI as a Biomarker of Cancer Therapy Cardiotoxicity

Overview

This systematic review and meta-analysis evaluated the role of MRI-derived extracellular volume (ECV) as a biomarker for detecting cardiotoxicity in patients undergoing cancer therapy. Findings suggest that ECV increases in patients after cardiotoxic treatments, reflecting myocardial tissue changes such as edema and fibrosis before overt cardiac dysfunction occurs.

Background

Cancer therapies, including anthracyclines, chest radiotherapy, and targeted agents, are associated with cardiotoxicity leading to significant morbidity and mortality. Current clinical detection relies on left ventricular ejection fraction (LVEF) decline and myocardial strain assessment, but these may miss early myocardial injury due to cardiac functional reserve. Parametric cardiac MRI techniques, particularly T1 mapping-derived ECV, offer a noninvasive method to quantify myocardial extracellular space, which increases with edema and fibrosis. Early detection of subclinical cardiotoxicity using ECV could enable timely therapeutic interventions to prevent progression to heart failure.

Data Highlights

Key Findings

• MRI-derived ECV increases significantly in patients exposed to cardiotoxic cancer therapies compared to controls.
• Elevated ECV correlates with myocardial edema and fibrosis, indicating subclinical myocardial injury.
• ECV changes can precede detectable declines in LVEF, offering earlier detection of cardiotoxicity.
• Use of ECV as a biomarker may guide preventive strategies such as dexrazoxane pre-treatment and personalized monitoring.
• Studies included were rigorously selected to exclude confounding cardiac comorbidities and unclear treatment regimens.

Clinical Implications

Incorporating MRI-derived ECV measurement into cardiooncology practice may enhance early identification of myocardial injury from cancer therapies before functional impairment occurs. This could facilitate timely interventions to mitigate progression to overt cardiotoxicity. Clinicians should consider ECV assessment alongside conventional imaging and biomarkers for comprehensive cardiac monitoring in at-risk patients.

Conclusion

MRI-derived extracellular volume is a promising biomarker for early detection of cancer therapy-related cardiotoxicity, reflecting myocardial tissue alterations that precede functional decline. Its integration into clinical protocols may improve patient outcomes through earlier diagnosis and tailored management.

References

1. European Society of Cardiology Guidelines 2022 -- Cardiooncology
2. PRISMA Statement 2009 -- Systematic Review Reporting Standards
3. QualSyst Tool 2004 -- Quality Assessment Criteria for Studies