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Diagnostics 2017, 7(4), 57; doi:10.3390/diagnostics7040057

A Score-Based Approach to 18F-FDG PET Images as a Tool to Describe Metabolic Predictors of Myocardial Doxorubicin Susceptibility

Nuclear Medicine, Policlinico San Martino Hospital and Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
Nuclear Medicine Unit, Department of Radiology, Uni-Klinikum, 72070 Tübingen, Germany
Clinic of Cardiovascular Diseases, Policlinico San Martino Hospital, 16132 Genoa, Italy
Ematology Unit, ASO Santa Croce e Carle, 12100 Cuneo, Italy
Clinic of Internal Medicine 3, Department Internal Medicine, Policlinico San Martino Hospital, 16132 Genoa, Italy
Department of Research, Innovation and Statistics, Antoine Lacassagne Cancer Centre, 06189 Nice, France
Epidemiology Unit, Policlinic San Martino Hospital, 16132 Genoa, Italy
CNR Institute of Bioimaging and Molecular Physiology, Section of Genoa, 20090 Milan, Italy
Author to whom correspondence should be addressed.
Received: 12 September 2017 / Revised: 13 October 2017 / Accepted: 23 October 2017 / Published: 26 October 2017
(This article belongs to the Section Medical Imaging)
View Full-Text   |   Download PDF [596 KB, uploaded 26 October 2017]   |  


Purpose: To verify the capability of 18F-fluorodeoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) to identify patients at higher risk of developing doxorubicin (DXR)-induced cardiotoxicity, using a score-based image approach. Methods: 36 patients underwent FDG-PET/CT. These patients had shown full remission after DXR-based chemotherapy for Hodgkin’s disease (DXR dose: 40–50 mg/m2 per cycle), and were retrospectively enrolled. Inclusion criteria implied the presence of both pre- and post-chemotherapy clinical evaluation encompassing electrocardiogram (ECG) and echocardiography. Myocardial metabolism at pre-therapy PET was evaluated according to both standardized uptake value (SUV)- and score-based approaches. The capability of the score-based image assessment to predict the occurrence of cardiac toxicity with respect to SUV measurement was then evaluated. Results: In contrast to the SUV-based approach, the five-point scale method does not linearly stratify the risk of the subsequent development of cardiotoxicity. However, converting the five-points scale to a dichotomic evaluation (low vs. high myocardial metabolism), FDG-PET/CT showed high diagnostic accuracy in the prediction of cardiac toxicity (specificity = 100% and sensitivity = 83.3%). In patients showing high myocardial uptake at baseline, in which the score-based method is not able to definitively exclude the occurrence of cardiac toxicity, myocardial SUV mean quantification is able to further stratify the risk between low and intermediate risk classes. Conclusions: the score-based approach to FDG-PET/CT images is a feasible method for predicting DXR-induced cardiotoxicity. This method might improve the inter-reader and inter-scanner variability, thus allowing the evaluation of FDG-PET/CT images in a multicentral setting. View Full-Text
Keywords: cardiotoxicity; doxorubicin; positron emission tomography; fluorodeoxy-glucose; myocardial metabolism; deauville score cardiotoxicity; doxorubicin; positron emission tomography; fluorodeoxy-glucose; myocardial metabolism; deauville score

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Bauckneht, M.; Morbelli, S.; Fiz, F.; Ferrarazzo, G.; Piva, R.; Nieri, A.; Sarocchi, M.; Spallarossa, P.; Canepari, M.E.; Arboscello, E.; Bellodi, A.; Massaia, M.; Gallamini, A.; Bruzzi, P.; Marini, C.; Sambuceti, G. A Score-Based Approach to 18F-FDG PET Images as a Tool to Describe Metabolic Predictors of Myocardial Doxorubicin Susceptibility. Diagnostics 2017, 7, 57.

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