Moyade Pamela, Vinjamuri Sobhan
Department of Nuclear Medicine, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK.
Nucl Med Commun. 2019 Oct;40(10):1081-1085. doi: 10.1097/MNM.0000000000001064.
The aim of this study was to evaluate the frequency and relative significance of incidental cardiac uptake on 68Ga-DOTA-peptide PET-CT scans in patients with neuroendocrine tumours/genetic syndromes expressing somatostatin receptors.
Scans of 1463 patients who underwent 68Ga-DOTA-peptide PET-CT scans in our department between 2013 and 2018 were retrospectively evaluated for the presence of uptake in the heart and/or its appendages.
out of 1463 patients (1.3%) demonstrated uptake of radio-peptide in the heart and/or its appendages. In 18 out of these 19 patients, the clinicians were unaware of possible cardiac involvement (one patient was a known case of cardiac paraganglioma). The primary neuroendocrine tumours and genetic syndromes associated with those with cardiac uptake of 68Ga-DOTA-peptide were as follows: unknown primary (n = 7), small bowel (n = 6), colon (n = 2), caecum (n = 1), pancreas (n = 1), cardiac paraganglioma (n = 1), Von Hippel Lindau syndrome (n = 1). Amongst the patients with neuroendocrine tumours, demonstrating cardiac uptake of 68Ga-DOTA-peptide, there was no clear association with carcinoid heart disease.
Our results are in agreement with established literature. The exact prognostic implication of cardiac involvement in patients with neuroendocrine tumours as well as other genetic syndromes expressing somatostatin receptors is unknown. We hypothesize that early detection and confirmation of cardiac metastasis(es) in these patients and introduction of different treatment regimes (such as Peptide Receptor Radionuclide Therapy), earlier in the course of the disease would reduce the disease burden on the heart and therefore contribute to better patient outcomes.
Cardiac involvement is a rare and hitherto less well-studied occurrence in neuroendocrine tumours, with an incidence in the range of 1%. To assess the possible prognostic implications, further detailed multicentre studies are required.
本研究旨在评估68Ga-DOTA肽PET-CT扫描中，生长抑素受体表达阳性的神经内分泌肿瘤/遗传综合征患者心脏意外摄取的频率及相对重要性。
回顾性评估2013年至2018年间在我科接受68Ga-DOTA肽PET-CT扫描的1463例患者的扫描结果，以确定心脏和/或其附属结构是否存在摄取。
1463例患者中有19例（1.3%）显示心脏和/或其附属结构有放射性肽摄取。在这19例患者中的18例中，临床医生未意识到可能存在心脏受累情况（1例患者为已知的心脏副神经节瘤病例）。与68Ga-DOTA肽心脏摄取相关的原发性神经内分泌肿瘤和遗传综合征如下：原发灶不明（n = 7）、小肠（n = 6）、结肠（n = 2）、盲肠（n = 1）、胰腺（n = 1）、心脏副神经节瘤（n = 1）、冯·希佩尔-林道综合征（n = 1）。在显示68Ga-DOTA肽心脏摄取的神经内分泌肿瘤患者中，与类癌性心脏病无明确关联。
我们的结果与现有文献一致。神经内分泌肿瘤以及其他生长抑素受体表达阳性的遗传综合征患者心脏受累的确切预后意义尚不清楚。我们推测，在这些患者中早期检测并确认心脏转移，并在疾病进程中更早地引入不同的治疗方案（如肽受体放射性核素治疗），将减轻心脏的疾病负担，从而有助于改善患者预后。
心脏受累在神经内分泌肿瘤中是一种罕见且迄今研究较少的情况，发病率约为1%。为评估可能的预后意义，需要进一步开展详细的多中心研究。
