Reduced Homogeneous Myocardial [18F]FDG Uptake in Routine PET/CT Studies as an Early Indicator of Chemotherapy-Induced Cardiotoxicity

Cardiotoxicity refers to the damage induced by antineoplastic treatments, leading to various cardiovascular conditions. [18F]FDG PET radiomics analysis could provide relevant information on early onset changes occurring in cardiac metabolism of chemotherapy-induced cardiotoxicity. Patients’ sociodemographic data, cardiovascular risk factors, laboratory parameters, and left ventricle [18F]FDG PET radiomic features are analyzed. The HRad index for the quantification of the heterogeneity of the metabolic uptake patterns is proposed. Statistical analysis is performed by separating patients according to the diagnosis of cancer therapy-related cardiac dysfunction (CTRCD). Baseline, intermediate, and end-of-treatment scans are evaluated as separate groups. Overall, CTRCD+ patients show lower overall mean standardized uptake values (SUVmean) compared to CTRCD− patients, with statistically significant differences between groups only observed in the intermediate PET study (p = 0.025). A total of 34 radiomic features show statistically significant differences between the CTRCD+ and CTRCD− groups in the intermediate imaging studies. In the CTRCD− group, greater overall heterogeneity of metabolic uptake is observed in the intermediate PET image compared to the CTRCD+ groups (p = 0.025). The assessment of CTRCD through [18F]FDG PET radiomics analysis could be a potential tool for the identification of a predisposition to the later development of cardiac complications after cardiotoxic treatment.