Abstract
Background
Somatostatin receptor is expressed in sarcoid granulomas, and preliminary clinical studies have shown that myocardial sarcoidosis can be identified on somatostatin receptor-targeted PET. We examined the potential clinical use of 68Ga-DOTATATE PET/CT for diagnosis and response assessment in cardiac sarcoidosis compared to 18F-FDG PET/CT.
Methods
Eleven cardiac sarcoidosis patients with 18F-FDG PET/CT were prospectively enrolled for cardiac 68Ga-DOTATATE PET/CT. The two PET/CT studies were interpreted independently and were compared for patient-level and segment-level concordance, as well as for the degree of radiotracer uptake. Follow-up 68Ga-DOTATATE PET/CT was performed in eight patients.
Results
Patient-level concordance was 91%: ten patients had multifocal DOTATATE uptake (active cardiac sarcoidosis) and one patient showed diffuse DOTATATE uptake. Segment-level agreement was 77.1% (Kappa 0.53 ± 0.07). The SUVmax-to-blood pool ratio was lower on 68Ga-DOTATATE PET/CT (3.2 ± 0.6 vs. 4.9 ± 1.5, P = 0.006 on paired t test). Follow-up 68Ga-DOTATATE PET/CT showed one case of complete response and one case of partial response, while 18F-FDG PET/CT showed four cases of response, including three with complete response.
Conclusion
Compared to 18F-FDG PET/CT, 68Ga-DOTATATE PET/CT can identify active cardiac sarcoidosis with high patient-level concordance, but with moderate segment-level concordance, low signal-to-background ratio, and underestimation of treatment response.
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Abbreviations
- CS:
-
Cardiac sarcoidosis
- PET:
-
Position emission tomography
- 18F-FDG:
-
Fluorine-18-fluorodeoxyglucose
- CMR:
-
Cardiac magnetic resonance imaging
- SSTR:
-
Somatostatin receptor
- 68Ga-DOTATATE:
-
Gallium-68-DOTATATE
- SUV:
-
Standardized uptake value
- CR:
-
Complete response
- PR:
-
Partial response
- NR:
-
No response
- 18F-FLT:
-
Fluorine-18-fluorothymidine
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Disclosure
No other potential conflicts of interest relevant to this article exist. No potential conflicts of interest relevant to this article exist for H.L., E.K.S., M.K.V., D.A.P., F.E.M., L.R.G., C.B.C., M.D.R., M.F.D., and P.E.B. D.A.P has provided the following financial interests not relevant to this article: Research Consultant, Five Eleven Pharma Inc.; Research Consultant, Progenics Pharmaceuticals Inc.; Research Consultant, Actinium Pharmaceuticals Inc.; Research Consultant, Ipsen; Research Grant, Siemens AG; Research Grant, Five Eleven Pharma Inc.; Research Grant, Progenics Pharmaceuticals Inc.; and Clinical Trial Funding, Nordic Nanovector ASA.
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The study was funded by the University of Pennsylvania Research Foundation and the Radiological Society of North America (RSD1903). Advanced Accelerator Applications, a Novartis Company, provided 68Ga-DOTATATE for the study.
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Lee, H., Schubert, E.K., Vidula, M.K. et al. Potential clinical utility of 68Ga-DOTATATE PET/CT for detection and response assessment in cardiac sarcoidosis. J. Nucl. Cardiol. 30, 1075–1087 (2023). https://doi.org/10.1007/s12350-022-03111-4
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DOI: https://doi.org/10.1007/s12350-022-03111-4