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CASE REPORT article

Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1527048
This article is part of the Research Topic Optimizing Cardiovascular Imaging for Unusual Clinical Scenarios: A Case-Based Approach View all 6 articles

Immune Checkpoint-Inhibitor Related Myotoxicity Monitoring using a Comprehensive Cardiothoracic MRI Approach: Insights from a Clinical Case

Provisionally accepted
Samia Boussouar Samia Boussouar 1,2,3*Etienne Charpentier Etienne Charpentier 1,2,3Baptiste Abbar Baptiste Abbar 2,4Jesus Gonzalez Jesus Gonzalez 2,5,6Thomas Similowski Thomas Similowski 1,2,5,6Mathieu Kerneis Mathieu Kerneis 2,7,8Yves ALLENBACH Yves ALLENBACH 1,2,9Marie Bretagne Marie Bretagne 1,10,11,2Joe Elie Salem Joe Elie Salem 1,10,11,2Alban Redheuil Alban Redheuil 1,12,2,3
  • 1 Hôpitaux Universitaires Pitié Salpêtrière, Paris, France
  • 2 Université Paris-Sorbonne, Paris, France
  • 3 Cardiovascular and Thoracic Imaging Unit, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), PARIS, France
  • 4 Sorbonne Université, INSERM CIC-1901, AP.HP.Sorbonne, Department of Pharmacology, UNICO-GRECO Cardio-Oncology Program, Pitié-Salpêtrière Hospital, Paris, France, paris, France
  • 5 INSERM U1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, Ile-de-France, France
  • 6 Département R3S (Respiration, Réanimation, Réhabilitation respiratoire, Sommeil), F-75013 Paris, France, PARIS, France
  • 7 ACTION Study Group, PARIS, France
  • 8 INSERM U1166 Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition, Paris, Île-de-France, France
  • 9 INSERM U974 Institut de Myologie, Paris, Île-de-France, France
  • 10 Department of Medical Oncology, Institut Universitaire de Cancérologie, CLIP² Galilée, Paris, France, Paris, France
  • 11 INSERM U1136 Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, Île-de-France, France
  • 12 INSERM U1146 Laboratoire d'Imagerie Biomédicale, Paris, Île-de-France, France

The final, formatted version of the article will be published soon.

    Recent advances in immunotherapy have significantly improved outcomes for cancer patients.However, therapies such as immune checkpoint inhibitors (ICIs) can lead to immune-related adverse events, including potentially fatal ICI-myocarditis. The diagnosis of ICI-myocarditis is complex, and cardiac MRI plays a crucial role in identifying this condition. This report presents a novel finding of elevated muscular T1 and T2 relaxation parameters using standard CMR sequences, correlating with the clinical progression of ICI-myotoxicity affecting not only the heart but also the skeletal thoracic muscles and the diaphragm. Identifying diaphragm involvement in these patients is particularly important, as it may result in respiratory failure. MRI has shown significant potential in assessing diaphragmatic function, as well as detecting tissue damage and edema, while also monitoring their evolution over time. This comprehensive, imaging-based approach could guide treatment decisions, including the use of corticosteroids and immunosuppressive therapies. Combining functional and non-invasive tissue assessments in a single MRI examination may enhance early diagnosis and improve the management of patients undergoing ICI therapy.

    Keywords: MRI, Immune check inhibitor (ICI), Diaphragm, thoracic, Cardiac, Myositis, diagnosis-

    Received: 12 Nov 2024; Accepted: 02 Jan 2025.

    Copyright: © 2025 Boussouar, Charpentier, Abbar, Gonzalez, Similowski, Kerneis, ALLENBACH, Bretagne, Salem and Redheuil. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Samia Boussouar, Hôpitaux Universitaires Pitié Salpêtrière, Paris, France

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.