Comparing Imaging and Pathology in Neuroendocrine Patients with Heart Disease

2066 Purpose: Carcinoid heart disease is relatively common among patients with a history of neuroendocrine tumors (NET) patients, thought to affect approximately 20% of those with carcinoid syndrome. Carcinoid heart disease is thought to be secondary to release of serotonin resulting in valvular fibrosis, rather than metastasis, however there has been little comparison data for this patient population. With increasing use of 68Ga-DOTATATE PET/CT for evaluation of NET, we are finding increasing number of cardiac metastasis. We sought to determine if there was a correlation in patients with carcinoid valve disease and those with cardiac metastasis detected on 68Ga-DOTATATE PET/CT. Materials and Methods: Following IRB approval and HIPAA compliant retrospective study, patients with NET and a 68Ga-DOTATATE PET/CT were identified from an internal radiology database. Then, using the medical record, patients with both a 68Ga-DOTATATE PET/CT and either carcinoid heart disease or cardiac metastasis were identified. Limited additional clinical information was reviewed including tumor pathology, valvular pathology, and surgical history. The 68Ga-DOTATATE PET/CTs were re-reviewed between 12/01/2016 to 11/01/2018 by a nuclear medicine Radiologist to confirm the presence or absence of cardiac metastasis. Only intracardiac metastases were included in this study. Results: Of the 379 patients with the mean age of 67.6 years, ranging from 41 to 88 years of age who have undergone 68Ga-DOTATATE PET/CT or PET/MR for carcinoid or NET, 34 patients (9%) had pathology proven carcinoid valve disease, 10 (2.6%) had intra-cardiac metastasis. Only 2 patients had both cardiac metastasis and valve disease, both with metastasis in the upper ventricular septum. All patients with carcinoid valve disease had replacement of the tricuspid valve and 31 (91%) also had pulmonary valve replacement. Conclusions: No patients with carcinoid valve disease had evidence of carcinoid metastasis on the valve by pathology. Two patients had both carcinoid valve disease and cardiac metastasis; however the prevalence of both is much higher suggesting the two pathologies are unrelated.