The role of cardiac MRI in cardio-oncology

Cardio-Oncology Fellowship Training and Education

PURPOSE OF REVIEW

With the rapid development of novel cancer therapeutics and the growing number of cancer survivors, there is significant demand for cardio-oncology experts to care for these patients. As such, it has become increasingly necessary to develop formalized training in the field of cardio-oncology. This review will focus on the current state of cardio-oncology education, with recommendations for the development of dedicated cardio-oncology fellowships.

RECENT FINDINGS

Cardio-oncology fellowships should be affiliated with high-volume centers that have established cardio-oncology clinical and research programs with dedicated cardio-oncology faculty. Several recent publications have proposed recommendations to develop uniform cardio-oncology training standards, core curricula, and evaluation metrics. With the rapid evolution of the field and the support of various profession organizations, the number and quality of dedicated cardio-oncology fellowship programs is expected to increase significantly. The adoption of defined training requirements and evaluation standards to measure competency will be essential to ensure the legitimacy and success of the field.

Evaluation and Management of Cardiac Tumors. Curr Treat Options Cardiovasc Med. 2018;20:29. [PMID: 29556752 DOI: 10.1007/s11936-018-0625-z]

PURPOSE OF REVIEW

Our purpose is to discuss the importance of multimodality imaging in the assessment of cardiac tumors and management. We have compiled a recent review of the scientific literature and embedded our clinical pathways and recommendations based on data and clinical experience.

RECENT FINDINGS

The use of contrast echocardiography in the assessment of cardiac masses has been shown to be helpful in distinguishing tumor from thrombus. Deformation imaging of cardiac tumors has been shown to differentiate better rhabdomyomas from fibromas in pediatric patients. Cardiac MRI (CMR) appears to be helpful in determining whether cardiac tumors are benign or malignant by identifying presence of infiltration, uptake of contrast in first pass perfusion and gadolinium enhancement. Patients with evidence of cardiac metastases by CMR show similar survival to stage IV cancer without cardiac metastases. In our institution, we use a standardized approach for the evaluation of cardiac masses, which includes multimodality imaging in the appropriate clinical context. The autotransplantation surgical technique has shown some promise in improving survival in patients with primary cardiac sarcomas. In our institution, we do not routinely recommend anticoagulation for "tumor-thrombus" in renal cell carcinoma due to risk of bleeding from primary tumor. Cardiac masses are often found incidentally, but sometimes can present with cardiovascular symptoms due to obstruction and valvular dysfunction, which may prompt imaging. It is important to determine whether the mass is a normal variant, imaging artifact, vegetation, thrombus, or tumor. Transthoracic echocardiography is ideally suited to be the initial imaging modality because of the portability, wide availability, lack of radiation, and relatively low cost. The gold standard cardiac imaging technique to distinguish tumor from thrombus is contrast enhanced CMR with prolonged inversion time. Advantages of CMR when compared to echocardiography regarding characterization of cardiac tumors are as follows: larger field of view, better spatial resolution, better tissue characterization, lack of attenuation, and ability to image at any prescribed plane. Primary and secondary cardiac tumors have particular characteristics in echocardiography and CMR. Imaging of cardiac tumors plays an important role in establishing a diagnosis and in planning management.