Hybrid imaging of neuroendocrine tumors in the heart: Union is strength

Abstract

Cardiac neuroendocrine tumors (NETs) are particularly rare tumors that can lead to a very poor clinical outcome, partly because of metastases but mainly because of manifestations of the hormonal activity they exhibit. Prompt diagnosis is important in order to start the most effective treatment for their removal or management, with the fewest complications. They are often difficult to diagnose, especially in their early stages. One of the reasons for this is that the heart is an organ with a high rate of metabolism and is located in close proximity to other highmetabolism organs. In addition, the anatomic location and their small size render their diagnosis extremely challenging. In recent years, hybrid imaging methods have revolutionized the diagnostic approach to oncology patients and have established a place in the diagnosis of cardiac NETs, because they provide both anatomical and functional information at the same time. Positron emission tomography/computed tomography (PET/CT), PET/magnetic resonance imaging (PET/MRI) and single-photon emission computed tomography/CT (SPECT/CT) are widely used in clinical practice because of the very important metabolic information, the high sensitivity and specificity. However, prospective studies are needed to confirm the true clinical and prognostic value of various hybrid imaging diagnostic techniques in cardiac NETs.

Cardiac metastases from neuroendocrine neoplasms: complementary role of SSTR PET/CT and cardiac MRI

“…Software packages can be utilized to retrospectively fuse PET functional information with CMR detailed anatomy (Figures 2 , 3 ), and the advantages of these hybrid approaches in NEN cardiac metastases have been previously reviewed. 34 Combined PET/MRI scanners may provide improved image co-registration but both scans would rarely be indicated at the same time unless cardiac metastases were known prior to referral or specific detailed imaging co-registration was required. Although PET/MRI has the advantage of combining both tests into a single study, disadvantages include the inevitable compromise between examination time, number of sequences performed, and image quality (with reduced spatial resolution accompanying the need for large field of view whole body imaging), suboptimal evaluation of the pulmonary parenchyma, and limited clinical availability in many parts of the world.…”