Chemotherapy-induced coronary arteries calcium score deterioration as detected with unenhanced CT portion of FDG PET/CT

This study aims to detect the potential impact of chemotherapy on the coronary calcium scoring (CCS) in lymphoma patients undergoing FDG-PET/CT at baseline and for therapy response using the CT portion of the exam to calculate the CCS. One hundred twelve lymphoma patients were included in the study based on having both baseline and at least 2 post-chemotherapy scans. The unenhanced CT portions of the scans were reviewed to measure the CCS which was then extracted using the Toshiba Vital Program. Agatston scores were assessed as category 1 with zero CCS unit and categories 2 to 5 having more than >1, 11, 101, and 400 CCS units respectively. For statistical analysis, paired T-Tests were used to compare results. The overall changes in total coronary artery calcium (CAC) from baseline to last treatment showed a statistically significant increase in CAC with an average increase of at least 35% in the CAC score. We also compared the overall changes in CAC with patients having category 1 and 2 Agatston at baseline and found no statistical increase in CAC post-chemotherapy. Additionally, we compared the overall changes in CAC with patients having category 3 and 4 Agatston at baseline and found statistically significant increase in CAC post-chemotherapy. In lymphoma patients, chemotherapy may cause worsening of CCS and this can serve as an early indicator of chemotherapy-induced cardiac toxicity. When present, such CCS deterioration can be detected by the unenhanced CT portion of routine oncologic FDG PET/CT scans.