Imaging techniques used to detect oncological treatment complications
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Oncological drugs are toxic for the cardiovascular system, directly affecting cardiac function and anatomy. Oncological treatment complications may thus take the form of asymptomatic myocardial dysfunction, overt heart failure, exacerbation of the symptoms of ischaemic heart disease, thromboembolic complications, arterial and pulmonary hypertension, pericardial complications, valvular disease and arrhythmia. Presently, we have a number of diagnostic tools at our disposal to detect cardiotoxicity, and the choice of one imaging technique over the others depends on the availability of that particular diagnostic method, and on its ability to provide optimum visualization. The basic method for cardiac assessment in oncological patients is transthoracic echocardiography (TTE). It is a widely available method which enables assessment of cardiac structures and haemodynamics without exposing the patient to an additional dose of ionizing radiation. In the case of poor TTE visualization, a recommended method for the assessment of cardiac function and structures is magnetic resonance. Chest, heart and coronary artery CT is also very useful in the diagnostics of oncological treatment complications. Moreover, cardiotoxicity diagnostics also involves nuclear medicine imaging techniques, including gated radionuclide ventriculography, whose advantage is high repeatability, with the disadvantage being the patient’s exposure to ionizing radiation and limited information on the structure and function of the myocardium. Both ECG-gated single photon emission computed tomography (SPECT) and positron emission tomography (PET) deliver information on the global and regional function of the left ventricle, presence of intraventricular synchrony, and myocardial perfusion. Early detection of subclinical dysfunction of the left ventricular myocardium in patients treated with potentially cardiotoxic drugs is well-grounded and aimed at the prevention of cardiovascular mortality by means of a primary prevention strategy.
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