Background Cardiac sarcoidosis is an inflammatory granulomatous condition of the heart, with significant morbidity and mortality, amenable to therapy. Immunosuppressive therapy is the mainstay of treatment in cardiac sarcoidosis. This study evaluates the usefulness of Ga-68 DOTANOC PET/CT (Positron Emission Tomography/Computed Tomography with 68 Gallium DOTA NaI3-octreotide) to evaluate the treatment response in cardiac sarcoidosis using semi-quantitative measures. 19 patients diagnosed with cardiac sarcoidosis were included in this prospective observational study. Informed consent was obtained from the participants to participate in the study. All patients received standard care of treatment and underwent pre- and post-therapy Ga- 68 DOTANOC PET/CT scans. SUVmax (maximum Standardized Uptake Value) and Disease Activity Score (DAS), calculated by the ratio of SUVmax of left ventricular (LV) myocardium to SUVmed (blood pool), were analyzed for treatment response evaluation. Results All patients had a positive pretherapy Ga- 68 DOTANOC PET/CT scan. The mean duration of treatment was 13.2 weeks. Significant regression in SUVmax was observed in 18 patients in the post-therapy scan compared to the baseline scan (1.47 ± 0.40 vs 2.67 ± 1.19, respectively, p-value = 0.001). Regression was also noted in the DAS (1.80 ± 0.52 vs 3.35 ± 1.20, p-value = 0.001). Clinical improvement was observed in all the patients, corresponding to the regression in SUVmax and DAS values. In addition to clinical response, reduction in SUVmax (− 0.58, p-value = 0.02) and DAS (− 0.74, p-value = 0.002) corresponded to an increase in Left Ventricular Ejection Fraction (LVEF) in 14 patients whose baseline LVEF was less than 50%. Relatively stable SUVmax and DAS were documented in one patient, who received alternate therapy then and showed regression in SUVmax in the subsequent follow-up scan. Conclusion Our study demonstrated that post-treatment Ga-68 DOTANOC PET/CT shows a reduction in the myocardial inflammatory burden. A negative correlation was also observed between the quantitative parameters (SUVmax and DAS) and LVEF, making Ga-68 DOTANOC PET/CT an effective modality for response assessment in cardiac sarcoidosis.

Somatostatin receptor imaging with Ga-68 DOTANOC PET/CT in the response assessment of cardiac sarcoidosis

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2025年10月6日

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Priyanka Murali Narmatha,
Indirani Muthukrishnan,
Dinesh Kumar Gauthaman,
Simon Shelly

摘要

Background

Cardiac sarcoidosis is an inflammatory granulomatous condition of the heart, with significant morbidity and mortality, amenable to therapy. Immunosuppressive therapy is the mainstay of treatment in cardiac sarcoidosis. This study evaluates the usefulness of Ga-68 DOTANOC PET/CT (Positron Emission Tomography/Computed Tomography with 68 Gallium DOTA NaI3-octreotide) to evaluate the treatment response in cardiac sarcoidosis using semi-quantitative measures. 19 patients diagnosed with cardiac sarcoidosis were included in this prospective observational study. Informed consent was obtained from the participants to participate in the study. All patients received standard care of treatment and underwent pre- and post-therapy Ga- 68 DOTANOC PET/CT scans. SUV_max (maximum Standardized Uptake Value) and Disease Activity Score (DAS), calculated by the ratio of SUV_max of left ventricular (LV) myocardium to SUV_med (blood pool), were analyzed for treatment response evaluation.

Results

All patients had a positive pretherapy Ga- 68 DOTANOC PET/CT scan. The mean duration of treatment was 13.2 weeks. Significant regression in SUV_max was observed in 18 patients in the post-therapy scan compared to the baseline scan (1.47 ± 0.40 vs 2.67 ± 1.19, respectively, p-value = 0.001). Regression was also noted in the DAS (1.80 ± 0.52 vs 3.35 ± 1.20, p-value = 0.001). Clinical improvement was observed in all the patients, corresponding to the regression in SUV_max and DAS values. In addition to clinical response, reduction in SUV_max (− 0.58, p-value = 0.02) and DAS (− 0.74, p-value = 0.002) corresponded to an increase in Left Ventricular Ejection Fraction (LVEF) in 14 patients whose baseline LVEF was less than 50%. Relatively stable SUV_max and DAS were documented in one patient, who received alternate therapy then and showed regression in SUV_max in the subsequent follow-up scan.

Conclusion

Our study demonstrated that post-treatment Ga-68 DOTANOC PET/CT shows a reduction in the myocardial inflammatory burden. A negative correlation was also observed between the quantitative parameters (SUV_max and DAS) and LVEF, making Ga-68 DOTANOC PET/CT an effective modality for response assessment in cardiac sarcoidosis.