Our objective was to evaluate the association of arterial 18 F-FDG uptake and calcifications in large arteries as detected by 18 F-FDG PET/CT with the subsequent occurrence of vascular events in otherwise asymptomatic cancer patients. Methods: Clinical follow-up information was obtained for 932 cancer patients examined with whole-body 18 F-FDG PET/CT (median follow-up time, 29 mo). Among this cohort, 279 patients had died from their oncologic disease. In 15 of 932 patients (1.6%), a vascular event, defined as ischemic stroke, myocardial infarction, or revascularization, was registered. The maximal standardized uptake value (SUV) was divided by the blood-pool SUV, yielding a target-to-background ratio (TBR) for each arterial segment. The mean TBR as well as a calcified plaque sum score per patient were calculated in the major vessels: ascending, descending, and abdominal aorta, aortic arch, as well as iliac and carotid arteries. Results: A significant correlation was observed between mean TBR and calcified plaque sum (P , 0.001). Although calcified plaque sum significantly correlated with all conventional risk factors for vascular events, mean TBR correlated only with age, the male sex, and hypertension. The Cox regression hazard model identified a mean TBR $ 1.7 and a calcified plaque sum $ 15 as independent predictors for the occurrence of a vascular event. Patients with both mean TBR and calcified plaque sum above these thresholds were identified as having the highest risk for a future vascular event. However, a mean TBR $ 1.7 had greater prognostic value than did a calcified plaque sum $ 15. Conclusion: In a large cohort of cancer patients, increased 18 F-FDG uptake in major arteries emerged as the strongest predictor of a subsequent vascular event. Concomitant severe vascular calcifications seemed to impart a particularly high risk. Given the small event rate in the present study, larger, prospective trials of patients without cancer are required to substantiate these promising results.

FDG uptake measurement in the LAD correlates with hypertension, coronary heart disease, BMI, PFV and CPB. However, due to myocardial FDG uptake these measurements are only feasible in one half of the patients.

To evaluate the effect of age, gender and cardiovascular risk factors on vessel wall inflammation and the calcified plaque burden in different vascular beds as assessed by PET/CT. 315 patients (mean age: 57.8 years, 123 male and 192 female) who underwent whole body 18F-FDG PET/CT examinations were included in the study. Blood pool-corrected standardised uptake value (TBR) and the calcified plaque score (CPS, grade 0-4) were determined in the thoracic and abdominal aorta, both common carotid and both iliac arteries. The following cardiovascular risk factors were documented: Age ≥65 years (n = 114), male gender (n = 123), diabetes (n = 15), hyperlipidemia (n = 62), hypertension (n = 76), body mass index (BMI) ≥ 30 (n = 38), current smoker (n = 32). Effects of risk factors on TBR and CPS in different arterial beds were assessed using multivariate regression analysis. In the thoracic aorta TBR was independently associated with age ≥65 years and male gender, CPS was independently associated with age ≥65 years, male gender, hypertension and diabetes. In the abdominal aorta, TBR was independently associated with age ≥65 years and male gender, CPS with age ≥65 years, diabetes and smoking. Independent associations in the carotid arteries were found for age ≥65 years, male gender and BMI ≥ 30 in TBR and for age ≥65 and diabetes in CPS. In the iliac arteries, TBR was independently associated with age ≥65 and CPS with age ≥65, male gender, hypertension, diabetes and smoking. Findings of this PET/CT study demonstrate that the impact of cardiovascular risk factors on vessel wall inflammation and calcified plaque burden differs across vascular territories. Overall, CPS was more closely associated with cardiovascular risk factors compared to TBR.

Contrary to a recent report, we found in our rather large cohort of elderly prostate cancer patients no significant association between FEC uptake in large vessels and atherosclerotic plaque burden, or the presence of cardiovascular risk factors. In line with prior reports on structural changes in vessels, increased calcified atherosclerotic plaque burden was strongly associated with the occurrence of common cardiovascular risk factors.

Background Atherosclerosis is a systemic disease which is associated with increased vascular inflammation. The purpose of this study was to correlate glucose-uptake of arterial walls as measured by 18F-FDG PET-CT with the occurrence of cardio- and cerebrovascular events. Methods: 1000 tumor patients were examined by whole-body 18F-FDG PET-CT between 2004 to 2007. Patients’ clinical follow-up information could be obtained in 650 patients by telephone interviews (mean follow-up time 3,1y). In 22/650 patients (3.3%), cardio- or cerebrovascular events were registered, defined as cardiac death, myocardial infarction or revascularization and stroke. 6 out of 22 patients were not evaluable because of ongoing or prior steroid medication. In total, 16 PET-CT’s of patients with cardiovascular events could be evaluated and compared to PET-CT’s of 300 consecutive patients with known cardiovascular risk factors. Maximum standardized uptake values were measured from arterial walls of the ascending, thoracic and abdominal aorta, iliac and carotid arteries and corrected by dividing with the blood pool uptake in the vena cava (target-to-background ratio, TBR). Occurrence of events was correlated with TBR, age, cardiovascular risk factors and presence of calcified plaques using the Spearman’s correlation coefficient R. Multiple linear regression analysis was used to accommodate for differences in risk factors. Statistical significance was considered to be present when p<0.01. Results: Occurrence of events was significantly correlated with coronary heart disease (R=0.33; p<.001), arterial hypertension (R=0.22; p<.001), presence of hard plaques (R=0.15; p=.007) and TBR values (R=0.28; p<.001). No other significant correlations were found. When performing multiple regression analysis the association between the occurrence of events and TBR values/presence of coronary heart disease remained significant (p<.001). Conclusion: The findings of this study suggest that a higher arterial wall glucose uptake in tumor patients is associated with the occurrence of future cardio- and cerebrovascular events. TBR values as measured by 18F-FDG PET-CT could be useful for identifying high-risk patients in need of intensified medical or interventional therapy.