TY - JOUR T1 - Doxorubicin Effect on Myocardial Metabolism as a Prerequisite for Subsequent Development of Cardiac Toxicity: A Translational <sup>18</sup>F-FDG PET/CT Observation JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1638 LP - 1645 DO - 10.2967/jnumed.117.191122 VL - 58 IS - 10 AU - Matteo Bauckneht AU - Giulia Ferrarazzo AU - Francesco Fiz AU - Silvia Morbelli AU - Matteo Sarocchi AU - Fabio Pastorino AU - Alberto Ghidella AU - Elena Pomposelli AU - Maurizio Miglino AU - Pietro Ameri AU - Laura Emionite AU - Flavia Ticconi AU - Eleonora Arboscello AU - Ambra Buschiazzo AU - Elena Augusta Massimelli AU - Salvatore Fiordoro AU - Anna Borra AU - Vanessa Cossu AU - Annalisa Bozzano AU - Adalberto Ibatici AU - Mirco Ponzoni AU - Paolo Spallarossa AU - Andrea Gallamini AU - Paolo Bruzzi AU - Gianmario Sambuceti AU - Cecilia Marini Y1 - 2017/10/01 UR - http://jnm.snmjournals.org/content/58/10/1638.abstract N2 - The present translational study aimed to verify whether serial 18F-FDG PET/CT predicts doxorubicin cardiotoxicity. Methods: Fifteen athymic mice were treated intravenously with saline (n = 5) or with 5 or 7.5 mg of doxorubicin per kilogram (n = 5 each) and underwent dynamic small-animal PET beforehand and afterward to estimate left ventricular (LV) metabolic rate of glucose (MRGlu). Thereafter, we retrospectively identified 69 patients who had been successfully treated with a regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine for Hodgkin disease (HD) and had undergone 4 consecutive 18F-FDG PET/CT scans. Volumes of interest were drawn on LV myocardium to quantify mean SUV. All patients were subsequently interviewed by telephone (median follow-up, 30 mo); 36 of them agreed to undergo electrocardiography and transthoracic echocardiography. Results: In mice, LV MRGlu was 17.9 ± 4.4 nmol × min−1 × g−1 at baseline. Doxorubicin selectively and dose-dependently increased this value in the standard-dose (27.9 ± 9 nmol × min−1 × g−1, P &lt; 0.05 vs. controls) and high-dose subgroups (37.2 ± 7.8 nmol × min−1 × g−1, P &lt; 0.01 vs. controls, P &lt; 0.05 vs. standard-dose). In HD patients, LV SUV showed a progressive increase during doxorubicin treatment that persisted at follow-up. New-onset cardiac abnormalities appeared in 11 of 36 patients (31%). In these subjects, pretherapy LV SUV was markedly lower with respect to the remaining patients (1.53 ± 0.9 vs. 3.34 ± 2.54, respectively, P &lt; 0.01). Multivariate analysis confirmed the predictive value of baseline LV SUV for subsequent cardiac abnormalities. Conclusion: Doxorubicin dose-dependently increases LV MRGlu, particularly in the presence of low baseline 18F-FDG uptake. These results imply that low myocardial 18F-FDG uptake before the initiation of doxorubicin chemotherapy in HD patients may predict the development of chemotherapy-induced cardiotoxicity, suggesting that prospective clinical trials are warranted to test this hypothesis. ER -