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Potential clinical utility of 68Ga-DOTATATE PET/CT for detection and response assessment in cardiac sarcoidosis

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

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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Authors and Affiliations

  1. Division of Nuclear Medicine Imaging and Therapy, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Hwan Lee MD, Erin K. Schubert BS, Daniel A. Pryma MD & Paco E. Bravo MD

  2. Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Mahesh K. Vidula MD, Francis E. Marchlinski MD, Lee R. Goldberg MD MPH & Paco E. Bravo MD

  3. Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Caitlin B. Clancy MD & Milton D. Rossman MD

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

    Marcelo F. DiCarli MD

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

    Marcelo F. DiCarli MD

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

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The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Rob deKemp, PhD.

Funding

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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