Purpose of Review The present review focus on the published literature about the use of 18F-fluorodeoxyglucose (FDG) PET/CT imaging in the early recognition of anthracyclines-related cardiotoxicity. Recent Findings The application of PET/CT may represent an early predictor of subsequent cardiotoxicity in cancer patients treated with doxorubicin (DXR). However, the application of PET/CT may also extend beyond mere cardiotoxicity identification and monitoring to provide mechanistic delineation of the cardiotoxic pathophysiology. Indeed, this tool further enriched the current knowledge on energy metabolism impairment in the DXR-induced cardiotoxic cascade. The capability of FDG to selectively track the early endoplasmic reticulum pentose phosphate pathway (PPP) response to oxidative stress rather than the later occurring contractile dysfunction might imply the abrupt occurrence of metabolic abnormality during the course of chemotherapy, possibly identifying the ongoing myocardial damage in time to change the chemotherapy scheme or to initiate targeted cardioprotective treatments. Future prospective studies encompassing a specific dietary or pharmacologic preparation before FDG injection, as already performed in infectious and inflammatory heart diseases, are needed to move the obtained preclinical findings supporting the role of FDG imaging in DXR cardiotoxicity from bench to bedside.
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