An image processing tool for the detection of anthracycline-induced cardiotoxicity by evaluating the myocardial metabolic activity in [(18)F]FDG PET/CT

PURPOSE: Chemotherapy-induced cardiotoxicity is one of the main complications during and after cancer treatment. While echocardiography is the most used technique in clinical practice to evaluate left ventricular (LV) dysfunction, a multimodal approach is preferred for the early detection of anthracycline-induced cardiotoxicity. In this paper, an image processing tool allowing the qualitative and quantitative analysis of myocardial metabolic activity by [(18)F]fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET/CT) images, acquired routinely during and after cancer treatment, is presented. METHODS: The methodology is based on cardiac single photon emission computed tomography image processing protocols used in clinical practice. LV polar maps are created, and quantitative regional values are calculated. The tool was validated in a study group of 24 patients with Hodgkin or non-Hodgkin lymphoma (HL and NHL, respectively) treated with anthracyclines. Staging, interim and end-of-treatment [(18)F]FDG PET/CT images were acquired and the presented tool was used to extract the quantitative metrics of LV metabolic activity. RESULTS: Results show an overall increase of metabolic activity in the interim PET image acquired while on treatment compared to staging PET, which then decreased in the end-of-treatment scan. Positive correlation coefficients between staging and interim scans, and negative correlation coefficients between interim and end-of-treatment scans also support this finding. Metabolic changes occur predominantly in the septal region. CONCLUSION: The proposed methodology and presented software solution provides the capability to assess quantitatively myocardial metabolism acquired by routine [(18)F]FDG PET/CT scanning during cancer treatment for evaluating anthracycline-induced cardiotoxicity. The [(18)F]FDG PET/CT septal-lateral uptake ratio is proposed as a new quantitative measure of myocardial metabolism. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11548-021-02508-9