ArticleLa Radiologia medica2026
Attenuation-based estimation of myocardial extracellular volume from ECG-ungated whole-body CT examinations as an early biomarker of chemotherapy-induced cardiotoxicity: preliminary findings.
Article in La Radiologia medica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate whether myocardial extracellular volume (ECV) could be estimated from whole-body CT examinations without electrocardiographic gating in cancer patients before and after the chemotherapy, with the goal to detect early-stage myocardial alterations heralding chemotherapy-induced cardiotoxicity. MATERIAL AND
methodsConsecutive patients receiving chemotherapy with a high (High-risk group) or low (Low-risk group) risk of cardiotoxicity were retrospectively enrolled. Patients underwent a whole-body CT examination for cancer staging before (CT-I) and after the first chemotherapy cycle (CT-II). Precontrast, arterial phase, and late post-contrast CT-I and CT-II images were analysed using in-house software. Myocardial Attenuation-based estimation of ECV (ABE-ECV) maps were generated from the combined analysis of regions of interest in precontrast images and a pixel-wise analysis of late post-contrast images, whereas the increase of myocardial and blood densities in arterial phase from basal values were compared to calculate arterial myocardial λ (arterial increase of myocardial density/increase of blood density).
resultsThe population included 89 patients (mean age 63 ± 14 years): 58 High-Risk and 31 Low-Risk. High-risk patients showed a significant increase of ABE-ECV of the interventricular septum, from 32% (31-35%) to 37% (35-39%) (p = 0.0002) and lateral wall, from 30% (27-31) to 32% (29-34) (p = 0.028). In contrast, Low-risk patients showed no significant variation of septal (p = 0.16) and LV lateral wall ABE-ECV (p = 0.93). Arterial myocardial λ at CT-II was reduced compared to CT-I in 31% of High-risk patients vs 10% of Low-risk patients (p = 0.036).
conclusionThis preliminary study demonstrated that ECV can be estimated in ECG-ungated whole-body CT examinations for cancer staging in patients undergoing chemotherapy. Potentially cardiotoxic chemotherapy can be associated with alterations of ABE-ECV and arterial myocardial λ.
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