Incidental cardiac findings on somatostatin receptor PET/CT: What do they indicate and are they of clinical relevance?

Abstract

We present the case of a 47-year-old man with a history of recurrent episodes of frontal headache, fever, and chest discomfort as well as longstanding, difficult to treat arterial hypertension. Clinical work-up revealed the unexpected finding of an underlying pheochromocytoma as well as recent “silent” myocardial infarction. Our case highlights the importance of paying attention to incidental cardiac findings on somatostatin receptor positron emission tomography/computed tomography, as routinely performed in patients with clinically suspected neuroendocrine tumors. These incidental cardiac findings cannot only indicate a primary or secondary (metastatic) neuroendocrine tumor, but also areas of myocardial inflammation, as somatostatin receptors cannot only be found on the majority of neuroendocrine tumors, but also among other tissues on the surface of activated macrophages and lymphocytes. The detection of myocardial inflammation is of clinical importance and its underlying etiology should be evaluated to prompt eventual necessary treatment, as it is a potential driving force for cardiac remodeling and poor prognosis.

PET/CT Imaging of Infectious Diseases: Overview of Novel Radiopharmaceuticals

“…It has also emerged in case reports or preliminary focused studies in the literature that the uptake of radiolabeled somatostatin receptor analogues in inflammation is a condition that is not rare and may occur in patients with neuroendocrine tumors [86].…”

“…In particular, cardiac uptake can indicate myocardial inflammation. Myocardial inflammation is a condition of clinical importance, and its underlying etiology should be further assessed to prompt eventual and necessary treatment, as it is linked to a poor prognosis [86].…”

Peculiarities of acute myocardial infarction course and distribution of the somatostatin receptor analogue 99mTc-octreotide in the heart

“…Окклюзия инфаркт-связанной коронарной артерии (у 5 (62,5%) vs 0 (0%) пациентов, р=0,016) чаще встречалась в группе с повышенным накоплением 99mTc-октреотида vs группе с пониженным, соответственно. Лабораторный анализ показал статистически значимое повышение вчСРБ при поступлении у пациентов с повышенной кумуляцией 99mTc-октреотида vs пониженной -31,6 мг/л (10,45-42,05) vs 6,5 мг/л (3,(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)8), р=0,043, соответственно. На инструментальном уровне установлено статистически значимое увеличение конечно-диастолического, конечно-систолического объемов ЛЖ; увеличение индекса сферификации ЛЖ и индекса нарушения локальной сократимости наряду со снижением фракции выброса ЛЖ в подгруппе с выраженным накоплением 99mTc-октреотида vs пониженным (47,5% (45,5-51,5) vs 57,5% (54-59), р=0,020) в зоне повреждения, соответственно.…”

“…[8,9]. Существуют единичные клинические работы, когда сходные результаты были получены авторами в качестве случайной находки [10] либо целенаправленного испытания [11].…”

Hybrid imaging of neuroendocrine tumors in the heart: Union is strength

“…78 However, in the case of PHEOs, the focus of the heart signs of inflammation or abnormal metabolism can be identified. 79 On the other hand, 18 F-DOPA, an amino acid analogue for PET tracing the catecholamine pathway, has been proposed as a good choice for PHEOs imaging as well. 80 Highly specific radiopharmaceuticals for PET have been developed, which reflect the uptake of hormone precursors, i.e.…”