INTERESTING IMAGE Year : 2023  |  Volume : 38  |  Issue : 1  |  Page : 69-70  

Imaging acute myocarditis with 68Ga-DOTANOC PET/CT

Jasim Jaleel1, Chetan D Patel1, Khangembam Bangkim Chandra1, Sivasubramanian Ramakrishnan2, Sandeep Seth2
1 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India

Date of Submission30-Jul-2022Date of Decision30-Aug-2022Date of Acceptance06-Sep-2022Date of Web Publication24-Feb-2023

Correspondence Address:
Dr. Chetan D Patel
Room No. 36, CN Centre, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/ijnm.ijnm_134_22

   Abstract 

Somatostatin receptor (SSTR) imaging is a useful method in the diagnosis of acute myocarditis. We present a case of a 54-year-old male with a clinical diagnosis of acute myocarditis in whom, 68Ga-DOTANOC positron emission tomography/computed tomography PET/CT showed diffuse left ventricular myocardial uptake. SSTR imaging can act as a surrogate marker of active inflammation. SSTR imaging is useful in deciding site of biopsy, assessing response to therapy and for prognostication.

Keywords: DOTANOC, myocarditis, positron emission tomography/computed tomography, somatostatin receptor

How to cite this article:
Jaleel J, Patel CD, Chandra KB, Ramakrishnan S, Seth S. Imaging acute myocarditis with 68Ga-DOTANOC PET/CT. Indian J Nucl Med 2023;38:69-70
How to cite this URL:
Jaleel J, Patel CD, Chandra KB, Ramakrishnan S, Seth S. Imaging acute myocarditis with 68Ga-DOTANOC PET/CT. Indian J Nucl Med [serial online] 2023 [cited 2023 Feb 28];38:69-70. Available from: https://www.ijnm.in/text.asp?2023/38/1/69/370425

A 54-year-old male presented to the emergency department with acute chest pain and breathlessness. Electrocardiogram showed ST elevation in anterior leads and bedside echocardiography showed severe left ventricular systolic dysfunction. Blood investigations showed elevated cardiac biomarkers. However, coronary angiogram revealed normal coronary arteries which excluded coronary artery disease. The patient was tested negative for COVID-19 infection. A clinical diagnosis of acute myocarditis was made. Cardiac Magnetic resonance imaging (MRI) revealed perimyocardial early and late gadolinium enhancement with edema in multiple regions including the septum, which were consistent with acute myocarditis. He was then referred for 68Ga-DOTANOC to look for active inflammatory process. 68Ga-DOTANOC positron emission tomography/computed tomography (PET/CT) [[Figure 1]a, [Figure 1]b, [Figure 1]c, d2] revealed diffuse heterogeneously increased radiotracer uptake in the entire left ventricular myocardium. 99mTc-Sestamibi myocardial perfusion imaging [[Figure 1] d1] showed a small perfusion defect in distal inferior wall. The patient was managed symptomatically and was started on oral corticosteroid therapy. The patient improved symptomatically.

Figure 1: Axial CT (a), PET (b), and fused PET/CT (c) images showed diffuse heterogeneously increased tracer uptake in the entire left ventricular myocardium. Conventional slices of short axis (left panel), vertical long axis (middle panel), and horizontal long axis (right panel) showed a small perfusion defect in distal inferior wall on 99mTc-MIBI perfusion study (d1) and diffuse radiotracer uptake in the left ventricular myocardium on 68Ga-DOTANOC PET (d2). PET: Positron emission tomography, CT: Computed tomography

Click here to view

Inflammatory cells shows somatostatin receptor (SSTR) expression, most commonly SSTR type 2.[1] SSTR imaging in myocardial inflammation has been reported previously in few cases. Baghel et al.[2] showed mild diffuse heterogeneous 68Ga-DOTANOC uptake in the left ventricular myocardium in a case of myocarditis. Amini et al.[3] performed 99mTc-Octreotide SPECT/CT in a patient with myocarditis, revealing diffuse tracer uptake in the left ventricular myocardium. Lapa et al.[4] compared SSTR PET/CT with MRI for the detection of myocardial inflammation, which showed a close spatial relationship between macrophage concentration and structural changes. Imaging has been tried with 99mTc-depreotide also, which also revealed diffuse tracer uptake in myocarditis.[5]

SSTR imaging can act as a surrogate marker of active inflammation, especially in cases where endomyocardial biopsy is difficult. Other advantages of SSTR imaging include, but not limited to, decide site of biopsy, assessing response to therapy and prognostication.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

   References 
1.Ten Bokum AM, Lichtenauer-Kaligis EG, Melief MJ, van Koetsveld PM, Bruns C, van Hagen PM, et al. Somatostatin receptor subtype expression in cells of the rat immune system during adjuvant arthritis. J Endocrinol 1999;161:167-75.  
    2.Baghel V, Kaushik P, Seth S, Patel C. Somatostatin analogue scintigraphy in myocardial inflammation: An interesting image. J Nucl Cardiol 2020;27:2436-7.  
    3.Amini A, Dehdar F, Jafari E, Gholamrezanezhad A, Assadi M. Somatostatin receptor scintigraphy in a patient with myocarditis. Mol Imaging Radionucl Ther 2021;30:50-3.  
    4.Lapa C, Reiter T, Li X, Werner RA, Samnick S, Jahns R, et al. Imaging of myocardial inflammation with somatostatin receptor based PET/CT – A comparison to cardiac MRI. Int J Cardiol 2015;194:44-9.  
    5.Spiridonidis T, Patsouras N, Papandrianos N, Symeonidis A, Apostolopoulos DJ. Tc-99m depreotide SPECT/CT depicts myocardial involvement in a case of thrombotic thrombocytopenic purpura. Clin Nucl Med 2008;33:874-5.  
    
  [Figure 1]