Somatostatin receptor based PET/CT in patients with the suspicion of cardiac sarcoidosis: an initial comparison to cardiac MRI
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Constantin Lapa1,*, Theresa Reiter2,3,*, Malte Kircher1, Andreas Schirbel1, Rudolf A. Werner1, Theo Pelzer2, Carmen Pizarro4, Dirk Skowasch4, Lena Thomas5, Ulrike Schlesinger-Irsch6, Daniel Thomas6, Ralph A. Bundschuh5, Wolfgang R. Bauer2,3,*, Florian C. Gärtner5,*
1Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
2Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
3Comprehensive Heart Failure Center, University Würzburg, Würzburg, Germany
4Department of Internal Medicine II - Pneumology/Cardiology, University Hospital Bonn, Bonn, Germany
5Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
6Department of Radiology, University Hospital Bonn, Bonn, Germany
*These authors have contributed equally to this work
Constantin Lapa, email: email@example.com
Keywords: sarcoidosis, DOTATOC, SSTR, somatostatin receptor, PET
Received: September 01, 2016 Accepted: October 12, 2016 Published: October 21, 2016
Diagnosis of cardiac sarcoidosis is often challenging. Whereas cardiac magnetic resonance imaging (CMR) and positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG) are most commonly used to evaluate patients, PET/CT using radiolabeled somatostatin receptor (SSTR) ligands for visualization of inflammation might represent a more specific alternative. This study aimed to investigate the feasibility of SSTR–PET/CT for detecting cardiac sarcoidosis in comparison to CMR.
15 patients (6 males, 9 females) with sarcoidosis and suspicion on cardiac involvement underwent SSTR-PET/CT imaging and CMR. Images were visually scored. The AHA 17-segment model of the left myocardium was used for localization and comparison of inflamed myocardium for both imaging modalities. In semi-quantitative analysis, mean (SUVmean) and maximum standardized uptake values (SUVmax) of affected myocardium were calculated and compared with both remote myocardium and left ventricular (LV) cavity.
SSTR-PET was positive in 7/15, CMR in 10/15 patients. Of the 3 CMR+/PET- subjects, one patient with minor involvement (<25% of wall thickness in CMR) was missed by PET. The remaining two CMR+/PET- patients displayed no adverse cardiac events during follow-up.
In the 17-segment model, PET/CT yielded 27 and CMR 29 positive segments. Overall concordance of the 2 modalities was 96.1% (245/255 segments analyzed). SUVmean and SUVmax in inflamed areas were 2.0±1.2 and 2.6±1.2, respectively. The lesion-to-remote myocardium and lesion-to-LV cavity ratios were 1.8±0.2 and 1.9±0.2 for SUVmean and 2.0±0.3 and 1.7±0.3 for SUVmax, respectively.
Detection of cardiac sarcoidosis by SSTR-PET/CT is feasible. Our data warrant further analysis in larger prospective series.
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