Scintigraphic Techniques for Early Detection of Cancer Treatment–Induced Cardiotoxicity

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FIGURE 1.
Calculation of heart-to-mediastinum count ratio of ¹²³I-MIBG. Region of interest (ROI) is drawn around left ventricle and in mediastinum. Mediastinal position of ROI is standardized in relation to lung apex, lower boundary of upper mediastinum, and mediastinal midline. Same ROIs are applied for early 15-min postinjection and late 4-h postinjection images, to calculate 4-h washout rates.where H is decay-corrected average counts of heart ROI, and M is decay-corrected average counts of mediastinum ROI.

TABLE 1

Cardiovascular Adverse Effects of Several Anticancer Agents

Effect	Agent
Myocardial depression	Anthracyclines, mitoxantrone, high-dose cyclophosphamide, trastuzumab, ifosfamide, all-trans retinoic acid
Ischemia	5-fluorouracil, cisplatin, capecitabine, interleukin-2
Hypotension	Etoposide, paclitaxel, alemtuzumab, cetuximab, rituximab, interleukin-2, denileukin, interferon-α, all-trans retinoic acid, homoharringtonine
Hypertension	Bevacizumab, cisplatin
Other	Busulfan (cardiac tamponade, endomyocardial fibrosis)
	Cyclophosphamide (hemorrhagic myocarditis)
	Paclitaxel, thalidomide (bradyarrhythmias)
	Arsenic trioxide (QT prolongation or torsades de pointes)

TABLE 2

Single-Photon Techniques for Early Detection of Cardiotoxicity

Technique	Tracer
Mechanical (pump) function	^99mTc MUGA (radionuclide ventriculography or equilibrium radionuclide angiocardiography)
	^99mTc gated blood-pool SPECT
Neuronal imaging	¹²³I-MIBG
	See Table 3 for neuronal imaging PET tracers
Imaging necrosis/cell death	¹¹¹In-antimyosin
Imaging cell death/apoptosis	^99mTc-annexin V
Fatty acid use	¹²³I-BMIPP
	¹²³I-paraphenyl pentadecanoic acid
Therapeutic target imaging	¹¹¹In-trastuzumab

TABLE 3

Radiotracers for Sympathetic Neuronal PET

Tracer	Action
Presynaptic tracers	Visualize inhibition of further neurotransmission
True catecholamines	Behave identically to endogenous neurotransmitters
¹⁸F-6-fluorodopamine
¹¹C-epinephrine
Catecholamine analogs	False neurotransmitters
¹¹C-meta-hydroxyephedrine (HED)
¹¹C-phenylephrine
¹⁸F-6-fluorometaraminol
Postsynaptic tracers	Visualize transmission of sympathetic signal to target tissue
¹¹C-CGP12177
¹¹C-CGP12388
¹¹C-GB67