Li Shilan, Tian Di, Li Xin, Li Jia, Song Qingwei, Xia Yunlong, Li Zhiyong
Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Front Cardiovasc Med. 2022 Sep 23;9:900309. doi: 10.3389/fcvm.2022.900309. eCollection 2022.
Anthracycline chemotherapy drugs can produce cardiotoxicity in patients with breast cancer, leading to myocardial cell death and fibrosis, further developing into cardiac failure. However, the condition of myocardial microcirculation was unknown in breast cancer after anthracycline chemotherapy. As a result, intravoxel incoherent motion (IVIM) imaging was used to non-invasively observe the condition of myocardial microcirculation in a patient with breast cancer after anthracycline chemotherapy.
A 43-year-old female patient with a right breast lump was reported. Preoperative ultrasound-guided needle biopsy showed invasive carcinoma of the right breast with fibroadenoma. Sentinel lymph node biopsy combined with simplified radical surgery for right breast cancer was performed. Postoperative pathological findings reported breast cancer (pT2N2M0 IIIA). The patient underwent eight sessions of the EC-TH chemotherapy scheme, and the EC and the TH schemes were adopted for the first four sessions and the last four sessions, respectively. During chemotherapy, during which there was the occurrence of Grade II myelosuppression, chest CT and abdomen CT showed no metastasis, and ECG and cardiac ultrasound reports returned to normal. Cardiac cine magnetic resonance and IVIM imaging were performed at the beginning of the first chemotherapy session (baseline) and after the third, fifth, and eighth chemotherapy sessions, respectively. We found that the fast apparent diffusion coefficient (ADC) and f parameters appeared to show a downward trend from the baseline to the fifth chemotherapy session, where the IVIM values declined from 163 × 10 mm/s to 148 × 10 mm/s and finally to 134 × 10 mm/s and f values declined from 45% to 36% and then to 30%, respectively. ADC and f values showed an inclination from the fifth and eighth chemotherapy sessions.
Our case report showed that IVIM technology can likely detect non-invasive myocardial microcirculation early and quantitatively after anthracycline chemotherapy in patients with breast cancer. That is, IVIM technology seems to be helpful for cardiovascular risk monitoring and prognosis assessment of myocardial microcirculation in patients with breast cancer after anthracycline chemotherapy.
蒽环类化疗药物可使乳腺癌患者产生心脏毒性，导致心肌细胞死亡和纤维化，进而发展为心力衰竭。然而，蒽环类化疗后乳腺癌患者的心肌微循环状况尚不清楚。因此，采用体素内不相干运动（IVIM）成像技术对1例蒽环类化疗后的乳腺癌患者心肌微循环状况进行无创观察。
报告1例43岁右乳肿块女性患者。术前超声引导下穿刺活检显示右乳浸润性癌伴纤维腺瘤。行前哨淋巴结活检联合右乳腺癌简化根治术。术后病理结果报告为乳腺癌（pT2N2M0 IIIA期）。患者接受8个周期的EC-TH化疗方案，前4个周期采用EC方案，后4个周期采用TH方案。化疗期间出现II度骨髓抑制，胸部CT和腹部CT均未显示转移，心电图和心脏超声报告均恢复正常。分别在第1个化疗周期开始时（基线）、第3个、第5个和第8个化疗周期后进行心脏电影磁共振成像和IVIM成像。我们发现，从基线至第5个化疗周期，快速表观扩散系数（ADC）和f参数呈下降趋势，IVIM值从163×10⁻³mm²/s降至148×10⁻³mm²/s，最终降至134×10⁻³mm²/s，f值分别从45%降至36%，然后降至30%。ADC和f值在第5个和第8个化疗周期后呈上升趋势。
我们的病例报告显示，IVIM技术可能在乳腺癌患者蒽环类化疗后早期无创地定量检测心肌微循环。也就是说，IVIM技术似乎有助于对蒽环类化疗后乳腺癌患者心肌微循环进行心血管风险监测和预后评估。
