Unmasking 5-fluorouracil cardiotoxicity: The clinical utility of dynamic myocardial CT perfusion: A case report

Q4 Medicine

Radiology Case Reports Pub Date : 2025-10-04 DOI:10.1016/j.radcr.2025.09.051

Mauricio Garcia-Cardenas MD , Gilberto H. Acosta-Gutiérrez MD , Nayat Rivera-Treviño MD , Hugo A. Valencia-Hernández MD , Enrique Ruiz-Mori MD , Nilda Espinola-Zavaleta PhD

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引用次数: 0

Abstract

We report the first documented case in Peru of 5-fluorouracil (5-FU)–induced cardiotoxicity assessed using combined coronary computed tomography angiography (CCTA) and dynamic myocardial computed tomography perfusion (CTP). A 57-year-old male with metastatic pancreatic cancer undergoing FOLFOX chemotherapy developed chest pain during the second cycle. Coronary computed tomography angiography (CCTA) revealed non-obstructive calcified plaques, ruling out significant coronary artery disease. Due to a history of active asthma, adenosine stress was contraindicated; therefore, a hyperventilation-apnea maneuver was employed as an alternative pharmacologic stress method. Dynamic CTP imaging demonstrated global myocardial hypoperfusion under stress conditions without infarction, consistent with coronary vasospasm induced by 5-FU. This case highlights the diagnostic value of combining anatomical and functional CT imaging modalities for noninvasive evaluation of cardiotoxicity in oncology patients. Additionally, the hyperventilation-apnea maneuver proved to be a feasible and safe stress alternative in patients contraindicated for pharmacologic agents. Further studies are warranted to establish the role of dynamic CTP in the early detection and management of fluoropyrimidine-induced cardiotoxicity.

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揭露5-氟尿嘧啶心脏毒性：动态心肌CT灌注的临床应用：1例报告

我们报告了秘鲁第一例5-氟尿嘧啶（5-FU）引起的心脏毒性，采用冠状动脉计算机断层血管造影（CCTA）和动态心肌计算机断层灌注（CTP）联合评估。一名57岁男性转移性胰腺癌患者接受FOLFOX化疗，在第二周期出现胸痛。冠状动脉ct血管造影（CCTA）显示非阻塞性钙化斑块，排除明显的冠状动脉疾病。由于有活动性哮喘病史，腺苷应激是禁忌；因此，采用过度通气-呼吸暂停操作作为替代的药理学应激方法。动态CTP成像显示应激状态下心肌全灌注不足，无梗死，与5-FU诱导的冠状动脉痉挛一致。本病例强调了结合解剖和功能CT成像方式对肿瘤患者心脏毒性无创评估的诊断价值。此外，过度通气-呼吸暂停操作被证明是一种可行和安全的应激替代患者禁忌症的药物。需要进一步的研究来确定动态CTP在氟嘧啶引起的心脏毒性的早期检测和管理中的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiology Case Reports Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

1.10

自引率

0.00%

发文量

1074

审稿时长

30 days

期刊介绍： The content of this journal is exclusively case reports that feature diagnostic imaging. Categories in which case reports can be placed include the musculoskeletal system, spine, central nervous system, head and neck, cardiovascular, chest, gastrointestinal, genitourinary, multisystem, pediatric, emergency, women''s imaging, oncologic, normal variants, medical devices, foreign bodies, interventional radiology, nuclear medicine, molecular imaging, ultrasonography, imaging artifacts, forensic, anthropological, and medical-legal. Articles must be well-documented and include a review of the appropriate literature.