title: Cardiac magnetic resonance imaging findings in 20-year survivors of mediastinal radiotherapy for Hodgkin's disease.
abstract: OBJECTIVE
  The recognition of the true prevalence of cardiac toxicity after mediastinal radiotherapy requires very long follow-up and a precise diagnostic procedure. Cardiac magnetic resonance imaging (MRI) permits excellent quantification of cardiac function and identification of localized myocardial defects and has now been applied to a group of 20-year Hodgkin's disease survivors.
  
  
  METHODS
  Of 143 patients treated with anterior mediastinal radiotherapy (cobalt-60, median prescribed dose 40 Gy) for Hodgkin's disease between 1978 and 1985, all 53 survivors were invited for cardiac MRI. Of those, 36 patients (68%) presented for MRI, and in 31 patients (58%) MRI could be performed 20-28 years (median, 24) after radiotherapy. The following sequences were acquired on a 1.5-T MRI: transversal T1-weighted TSE and T2-weighted half-fourier acquisition single-shot turbo-spin-echo sequences, a steady-state free precession (SSFP) cine sequence in the short heart axis and in the four-chamber view, SSFP perfusion sequences under rest and adenosine stress, and a SSFP inversion recovery sequence for late enhancement. The MRI findings were correlated with previously reconstructed doses to cardiac structures.
  
  
  RESULTS
  Clinical characteristics and reconstructed doses were not significantly different between survivors undergoing and not undergoing MRI. Pathologic findings were reduced left ventricular function (ejection fraction <55%) in 7 (23%) patients, hemodynamically relevant valvular dysfunction in 13 (42%), late myocardial enhancement in 9 (29%), and any perfusion deficit in 21 (68%). An association of regional pathologic changes and reconstructed dose to cardiac structures could not be established.
  
  
  CONCLUSIONS
  In 20-year survivors of Hodgkin's disease, cardiac MRI detects pathologic findings in approximately 70% of patients. Cardiac MRI has a potential role in cardiac imaging of Hodgkin's disease patients after mediastinal radiotherapy.
authors.affiliation: Department of Radiology, University of Würzburg, Würzburg, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Machann
authors.forename: Meinrad
authors.initials: M
authors.lastname: Beer
authors.forename: Margret
authors.initials: M
authors.lastname: Breunig
authors.forename: Stefan
authors.initials: S
authors.lastname: Störk
authors.forename: Christiane
authors.initials: C
authors.lastname: Angermann
authors.forename: Ines
authors.initials: I
authors.lastname: Seufert
authors.forename: Franz
authors.initials: F
authors.lastname: Schwab
authors.forename: Oliver
authors.initials: O
authors.lastname: Kölbl
authors.forename: Michael
authors.initials: M
authors.lastname: Flentje
authors.forename: Dirk
authors.initials: D
authors.lastname: Vordermark
mesh_terms: D000328:Adult; D000368:Aged; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000528:radiation effects*; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D011879:Radiotherapy Dosage; D017741:Survivors; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D003037:Cobalt Radioisotopes