Which imaging modality is appropriate to assess left ventricular function prior to doxorubicin?

• A. Both MUGA and echocardiography
• B. MUGA
• C. Echocardiography
• D. PET scan

Answer: (A)

Assessing baseline left ventricular function is essential before starting doxorubicin because cardiotoxicity risk hinges on how well the heart is working before treatment and on detecting early declines during therapy. The key measurement is left ventricular ejection fraction (EF), which guides dosing, monitoring frequency, and potential changes in therapy.

Two imaging options can reliably provide that EF and are commonly used in this context. Echocardiography uses ultrasound to estimate EF (often with the Simpson method) and can also evaluate LV size, wall motion, and valvular function; it has no radiation and is widely available, with the added benefit of newer techniques like strain imaging for detecting subclinical dysfunction. MUGA scans (multigated acquisition) offer highly reproducible EF measurements and excellent precision for serial comparisons, though they involve radiation exposure. Because the aim is accurate baseline EF assessment, either modality can be appropriate, depending on patient factors and resources. PET is not routinely used for baseline LV function in this setting.