Title: Imaging guided in-vivo histological validation of cardiac sarcoid using 68Ga- DOTATATE and novel PET-MR methods.
Funder: The Academy of Medical Sciences

Abstract: Cardiac Sarcoidosis (CS) remains a diagnostic challenge for clinicians and is an important cause of heart failure and death. There is no single test for accurate diagnosis, although Cardiovascular Magnetic Resonance (CMR) and Positron Emission Tomography (PET) are recommended in recent guidelines. The aim of this project is to investigate whether a novel approach using advanced imaging may improve the diagnosis of CS in a pilot study. The specific objectives are to (i) assess the diagnostic value of 68Ga-DOTATATE tracer combined with hybrid PET-MR imaging in patients with suspected CS and (ii) to use hybrid PET-MR imaging to localise sarcoid foci in the myocardium, overlay imaging data onto fluoroscopy in the catheter lab in order to guide myocardial biopsy for tissue diagnosis. I plan to use hybrid PET-MR imaging using a novel PET tracer, 68Ga-DOTATATE, for assessment of inflammation and combine with multiparametric CMR with cine imaging, T1/T2, rest perfusion and late gadolinium enhancement to better characterise the disease process and improve diagnosis. Using this combined approach, I will attempt to localise sarcoid foci using image co-registration and overlay on fluoroscopy in the cathlab. I will correlate imaging findings with histological changes to determine the diagnostic accuracy of this approach. The findings of this pilot study will help to determine whether this proposed method may enhance the diagnosis of CS, and if deemed successful, will lead to future projects for diagnostic accuracy, prognosis and response to therapeutics.

Lay abstract: Cardiac Sarcoidosis (CS) is a condition of the heart which may cause abnormal heart rhythms, pump failure of the heart muscle, and in some cases even death. Testing for CS is challenging for clinicians, although MRI and Positron Emission Tomography (PET) are recommended in guidelines, but there is no single best test. I aim to use both imaging tests with PET-MR imaging (a special scan which allows for MRI and PET in one scan) and a new PET tracer in 10 patients with suspected CS to assess whether this new method may improve the way we detect CS. I will also combine the images from PET-MR into a single set of images, and project this onto a screen in the catheter lab. I will then use these images to help identify which areas of the heart may have CS, and then biopsy these specific areas, guided by the images. This is important as it will allow us to confirm our findings from imaging with the ground truth at the level of the heart. This study is important as we don’t have a perfect test for CS. We need to test if this method works in a few patients before we consider undertaking a much larger project with more patients. We hope that the findings may help to improve the detection of CS, which remains a challenge to doctors. Ultimately, if this test does prove to work, this new test may improve testing for CS and also help to guide treatments.

Research activity codes: 4.1 DISCOVERY AND PRECLINICAL TESTING OF MARKERS AND TECHNOLOGIES
Health categories: CARDIOVASCULAR