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Feasibility of somatostatin receptor-targeted imaging for detection of myocardial inflammation: A pilot study

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Gallium-68 Dotatate binds preferentially to somatostatin receptor (sstr) subtype-2 (sstr-2) on inflammatory cells. We aimed at investigating the potential clinical use of sstr-targeted imaging for the detection of myocardial inflammation.

Methods

Thirteen patients, with suspected cardiac sarcoidosis (CS) based on clinical history and myocardial uptake on recent fluorine-18 fluorodeoxyglucose (FDG) PET, were enrolled to undergo Dotatate PET after FDG-PET (median time 37 days [IQR 25-55]). Additionally, we investigated ex-vivo the immunohistochemistry expression of sstr-2 in 3 explanted sarcoid hearts.

Results

All FDG scans showed cardiac uptake (focal/multifocal = 6, focal on diffuse/heterogeneous = 7), and 46% (n = 6) extra-cardiac uptake (mediastinal/hilar). In comparison, Dotatate scans showed definite abnormal cardiac uptake (focal/multifocal) in 4 patients, probably abnormal (heterogenous/patchy) in 3, and negative uptake in 6 cases. Similarly, 6 patients had increased mediastinal/hilar Dotatate uptake. Overall concordance of FDG and Dotatate uptake was 54% in the heart and 100% for thoracic nodal activity. Quantitatively, FDG maximum standardized uptake value was 5.0 times [3.8-7.1] higher in the heart, but only 2.25 times [1.7-3.0; P = .019] higher in thoracic nodes relative to Dotatate. Ex-vivo, sstr-2 immunostaining was weakly seen within well-formed granulomas in all 3 examined sarcoid heart specimens with no significant staining of background myocardium or normal myocardium.

Conclusion

Our preliminary data suggest that, compared to FDG imaging, somatostatin receptor-targeted imaging may be less sensitive for the detection of myocardial inflammation, but comparable for detecting extra-cardiac inflammation.

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Abbreviations

PET:

Positron emission tomography

FDG:

Fluorodeoxyglucose

sstr-2:

Somatostatin receptor (sstr) subtype-2

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Acknowledgments

This work was supported by a grant from the Radiological Society of North America Research & Education Foundation Board of Trustees (RF1632), Institutional Funds, and a Training Grant from the National Institutes of Health (1T32HL094301).

Disclosure

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Cardiovascular Imaging Program, Heart and Vascular Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Paco E. Bravo MD, Navkaranbir Bajaj MD, MPH, Victoria Morgan BS, Jon Hainer BS, Courtney F. Bibbo CNMT, Meagan Harrington CNMT, Mi-Ae Park PhD, Sharmila Dorbala MD, MPH, Ron Blankstein MD & Marcelo F. Di Carli MD

  2. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Paco E. Bravo MD, Navkaranbir Bajaj MD, MPH, Victoria Morgan BS, Jon Hainer BS, Courtney F. Bibbo CNMT, Meagan Harrington CNMT, Mi-Ae Park PhD, Hyewon Hyun MD, Matthew Robertson MD, Sharmila Dorbala MD, MPH, Ron Blankstein MD & Marcelo F. Di Carli MD

  3. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Paco E. Bravo MD, Navkaranbir Bajaj MD, MPH, Neal K. Lakdawala MD, John Groarke MD, MPH, Garrick C. Stewart MD, Sharmila Dorbala MD, MPH, Ron Blankstein MD & Marcelo F. Di Carli MD

  4. Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Robert F. Padera MD, PhD

  5. Divisions of Nuclear Medicine and Cardiology, Departments of Radiology and Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Paco E. Bravo MD

  6. Division of Cardiology, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Navkaranbir Bajaj MD, MPH

  7. Divisions of Nuclear Medicine and Cardiology, Departments of Radiology and Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 11-154 South Pavilion, Philadelphia, PA, 19104, USA

    Paco E. Bravo MD

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  1. Paco E. Bravo MD
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Correspondence to Paco E. Bravo MD.

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Bravo, P.E., Bajaj, N., Padera, R.F. et al. Feasibility of somatostatin receptor-targeted imaging for detection of myocardial inflammation: A pilot study. J. Nucl. Cardiol. 28, 1089–1099 (2021). https://doi.org/10.1007/s12350-019-01782-0

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