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Arnfield EG, Tam L, Pattison DA, Younger J, Chikatamarla VA, Wyld D, Burge M, McCormack L, Ladwa R, Ramsay S. Cardiac metastases from neuroendocrine neoplasms: complementary role of SSTR PET/CT and cardiac MRI. J Nucl Cardiol 2023; 30:2676-2691. [PMID: 37587328 PMCID: PMC10682059 DOI: 10.1007/s12350-023-03345-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/28/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Cardiac metastases from neuroendocrine neoplasms (NENs) are being detected with increasing frequency, although the optimal imaging strategy remains unclear. We performed a single-center retrospective study to explore the role of somatostatin receptor positron emission tomography/computed tomography (SSTR PET/CT) and cardiac magnetic resonance imaging (CMR) in NEN cardiac metastases, determine the degree of concordance between the findings of these imaging modalities, and examine the advantages and disadvantages of each imaging technique. A secondary aim was to determine if cardiac metastases were associated with adverse cardiac events during peptide receptor radionuclide therapy (PRRT). METHODS AND RESULTS 19 patients with NEN cardiac metastases were identified. A retrospective review of electronic medical records was performed, and if available SSTR PET/CT and CMR were blindly re-reviewed by imaging specialists, documenting the number and location of cardiac metastases. All 19 patients had SSTR PET/CT, and 10/19 patients had CMR. SSTR PET/CT identified more metastases than CMR. When identified on CMR, metastases were more accurately localized. 12/19 patients received PRRT, with no cardiac adverse effects. CONCLUSION SSTR PET/CT and CMR are complementary investigations in the imaging of NEN cardiac metastases. SSTR PET/CT appears more sensitive for lesion detection, and CMR offers better lesion characterization. Both investigations present useful information for the planning of treatment including PRRT, which was administered safely.
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Affiliation(s)
- Evyn G Arnfield
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4006, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Laura Tam
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - David A Pattison
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4006, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - John Younger
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Venkata Avinash Chikatamarla
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4006, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David Wyld
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Matthew Burge
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Louise McCormack
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Rahul Ladwa
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Stuart Ramsay
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4006, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Wang Y, Ayoub C, Yang AF, Sonbol MB, Butterfield R, Halfdanarson TR, Arsanjani R, Zhu W, Yang M. Gastroenteropancreatic Neuroendocrine Tumor Metastasis to the Heart: Evaluation of Imaging Manifestations. Curr Probl Diagn Radiol 2023; 52:340-345. [PMID: 36473799 PMCID: PMC10189797 DOI: 10.1067/j.cpradiol.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
Neuroendocrine tumors (NET) may affect the heart by cardiac metastasis or carcinoid heart disease. NET metastasis to the heart is rare, with limited data characterizing it. We sought to evaluate 68Ga-DOTATATE PET scan imaging features and associated cardiac imaging characteristics where available in those with NET cardiac metastases. 68Ga-DOTATATE positron emission tomography (PET)/CT scans performed on patients with gastroenteropancreatic (GEP) NET at our institution were reviewed for cardiac involvement. Those identified with cardiac metastases had their electronic medical record, transthoracic echocardiogram (TTE) and cardiac magnetic resonance imaging (MRI) reviewed for characterization. From a total of 1426 68Ga-DOTATATE PET/CT scans performed on patients with GEP-NET, 25 (1.75%) had cardiac uptake consistent with metastasis. Of these, 22 had myocardial metastases (29 distinct myocardial lesions: left ventricle - 16, right ventricle - 6, and ventricular septum -7) and 3 had periradial lymph node involvement only. NET patients with cardiac metastases as identified by DOTATATE scan did not appear to have any hemodynamically significant TTE features, aside from those (2/25) who had concomitant carcinoid heart disease. Of the 14 patients who had available TTE for review, only one with high metastatic cardiac tumor burden had detectable cardiac mass. Of the 6 cases who had available MRI, all had metastatic cardiac lesions seen with excellent correlation with tumor localization on 68Ga-DOTATATE PET scan. 68Ga-DOTATATE PET has excellent capability for the diagnosis of cardiac NET metastasis. Cardiac MRI may provide further anatomic and tissue characterization evaluation. Those with myocardial NET metastases without carcinoid heart disease did not have significant hemodynamic effect based on echocardiographic criteria.
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Affiliation(s)
- Yuxiang Wang
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Chadi Ayoub
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Aaron F Yang
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | | | | | | | - Reza Arsanjani
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Wuqiang Zhu
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Ming Yang
- Department of Radiology, Mayo Clinic, Scottsdale, AZ.
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