To evaluate the diagnostic capability of Spectral CT, performed with contrast agent
during routine oncological follow-ups, in detecting signs of acute and chronic
early-onset cardiac toxicity caused by anthracyclines in patients with Hodgkin's lymphoma
and diffuse large B-cell lymphoma undergoing treatment regimens including
anthracycline-based drugs. Spectral CT provides advanced data, such as iodine maps and
tissue characterization, allowing for the identification and quantification of hyperemia,
edema, and fibrosis. These findings are particularly promising in cardiovascular imaging,
where tissue characterization and early detection of myocardial damage (edema or
fibrosis) are traditionally achieved with cardiac MRI (cardio-MRI).
In clinical oncology, anthracyclines improve survival rates but are associated with
cardiotoxic effects, classified as acute (up to two weeks after therapy), early chronic
(within one year), or late chronic (years or decades later), often irreversible.
Anthracycline-related cardiac toxicity is dose-dependent and varies from subclinical
alterations to overt symptoms such as arrhythmias, fibrosis, and heart failure. Early
detection of myocardial damage with imaging techniques is critical for initiating
cardioprotective therapy, which can significantly improve cardiac outcomes.
Currently, functional imaging modalities like echocardiography and cardio-MRI are used.
While echocardiography offers functional data such as LVEF and strain, cardio-MRI
provides more precise and reproducible measurements and structural data (e.g., edema via
T2 mapping and fibrosis via late gadolinium enhancement, LGE). Structural markers, such
as positive LGE and elevated T1 mapping or ECV values, are highly sensitive and can
detect damage before functional decline, enabling earlier intervention. However,
cardio-MRI has limitations, such as long acquisition times, high costs, and
contraindications like claustrophobia.
With the introduction of Spectral CT, studies have shown that advanced CT scanners can
also visualize and quantify myocardial fibrosis (as late-iodine enhancement, LIE) and
measure ECV, comparable to cardio-MRI. This suggests that Spectral CT could become a
"one-stop-shop" modality, capable of assessing both the patient's primary disease and
signs of anthracycline-induced cardiotoxicity through post-processing of the same images,
even in subclinical stages.