Factors Associated with Myocardial Uptake on Oncologic Somatostatin PET Investigations and Differentiation from Myocardial Uptake of Acute Myocarditis - Université de Lorraine
Article Dans Une Revue Journal of Nuclear Medicine Année : 2024

Factors Associated with Myocardial Uptake on Oncologic Somatostatin PET Investigations and Differentiation from Myocardial Uptake of Acute Myocarditis

Jeanne Varlot
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Résumé


Myocardial somatostatin-PET uptake is observed in most patients with acute myocarditis (AM) but also in some oncology patients referred for routine somatostatin-PET. This raises concerns about the specificity of somatostatin-PET for detecting myocarditis. The current study aims to identify (i) factors associated with the detection of myocardial uptake on somatostatin-PET recorded for oncology indications and (ii) differential PET criteria that characterize myocardial uptake in AM patients.
Methods. We analyzed i) factors associated with the detection of myocardial [68Ga]Ga-DOTA-TOC uptake in 508 [68Ga]Ga-DOTA-TOC PETs from 178 patients, performed for a confirmed or suspected oncologic disease (Onc-PET group) and ii) PET criteria that could differentiate myocardial [68Ga]Ga-DOTA-TOC uptake in 31 patients with an MRI-ascertained AM (AM-PET group) from the Onc-PET group.
Results. Significant myocardial uptake was detected in 137 (26.9%) Onc-PETs and was independently associated with somatostatin analog treatment (Exp(Beta) (95 %CI): 0.805 (0.728-0.890), p<0.001) and age (1.005 (1.001-1.009), p=0.012). A comparable model was selected for predicting the myocardial/blood SUVmax ratio (i.e. somatostatin analog treatment (p<0.001) and history of coronary artery disease (CAD) p=0.022)). Myocardial uptake was detected in 12.9% (25/193) of Onc-PETs from patients treated with somatostatin analogs but in 43.4% (59/136) of untreated patients over the median of 64 years of age. Myocardial uptake was apparent in all 31 AM-PETs, with volume and intensity of uptake dramatically higher than in the 137 Onc-PETs showing myocardial uptake. A myocardial/blood SUVmax ratio threshold of 2.20 provided a sensitivity of 87% (27/31) and a specificity of 88% (44/50) for differentiating myocardial uptake between AM-PETs and an Onc-PET group restricted to patients with comparable clinical characteristics to the AM group (≤ 64 years of age, no CAD history, no somatostatin agonists). A myocardial uptake volume threshold of 18 cm3 provided a comparable diagnostic accuracy (sensitivity: 84% (26/31), specificity: 94% (47/50)).
Conclusion. Myocardial uptake is detected in 26.9% of somatostatin-PETs recorded for oncology indications. This rate is decreased by somatostatin analog treatments and increased in older individuals. However, somatostatin-PET, analyzed with the quantitative criterion of uptake intensity or volume, is able to identify acute myocarditis and to differentiate it from myocardial uptake of other origins.
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Dates et versions

hal-04651722 , version 1 (17-07-2024)

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Thomas Larive, Caroline Boursier, Marine Claudin, Jeanne Varlot, Laura Filippetti, et al.. Factors Associated with Myocardial Uptake on Oncologic Somatostatin PET Investigations and Differentiation from Myocardial Uptake of Acute Myocarditis. Journal of Nuclear Medicine, 2024, 65 (8), pp.1279-1285. ⟨10.2967/jnumed.123.267219⟩. ⟨hal-04651722⟩
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