18F-FDG accumulation in atherosclerosis: use of CT and MR co-registration of thoracic and carotid arteries

Okane, Kumiko; Ibaraki, Masanobu; Toyoshima, Hideto; Sugawara, Shigeki; Takahashi, Kazuhiro; Miura, Shuichi; Shimosegawa, Eku; Satomi, Junichiro; Kitamura, Kazuhiro; Satoh, Tomohiko

doi:10.1007/s00259-005-0005-2

Cited by 44 publications

(24 citation statements)

References 11 publications

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“…18 F-FDG PET/CT, if proven, may offer an attractive alternative to vulnerable plaque imaging in some patients. The ability of this method to reliably measure aortic and carotid active plaque has been now demonstrated in several studies (4,35,36). Coronary imaging has been limited, however, by the myocardial uptake.…”

Section: Discussionmentioning

confidence: 98%

Imaging of Inflamed and Vulnerable Plaque in Coronary Arteries with ¹⁸F-FDG PET/CT in Patients with Suppression of Myocardial Uptake Using a Low-Carbohydrate, High-Fat Preparation

Wykrzykowska¹,

Lehman²,

Williams³

et al. 2009

J Nucl Med

248

151

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PET/CT imaging with 18 F-FDG has been used to detect inflammation in carotid and aortic plaque; its use in detecting coronary plaque has been limited by avid 18 F-FDG uptake by the myocardium. We investigated whether 18 F-FDG PET/CT could be used to image inflammation in coronary arteries as a potential noninvasive method to detect vulnerable plaque. Methods: We retrospectively studied 32 patients treated for malignancy who underwent 18 F-FDG PET/CT and concomitant cardiac catheterization. As part of the recently described protocol, all patients were instructed to eat a low-carbohydrate, high-fat meal the night before and drink a vegetable oil drink the morning of the study. We reviewed the patients' baseline characteristics and their 18 F-FDG PET/CT scans for adequacy of myocardial uptake suppression and correlated the presence of angiographically apparent plaque with 18 F-FDG uptake in the major coronary arteries. Two independent observers assessed the angiographic images and 18 F-FDG PET scans. Results: A total of 95% of patients had 2 or more coronary disease risk factors, and 25% had unstable symptoms; 30% of index catheterizations resulted in intervention. In 20 of 32 patients (63%), myocardial suppression was good (12) or adequate (8). Inadequate suppression was due to self-reported dietary nonadherence. Patients with good, adequate, and poor suppression had maximal myocardial standardized uptake values of 2.8 6 0.7, 5.0 6 1.3, and 17.0 6 9.7, respectively. We identified 18 F-FDG uptake in 15 patients in 1 or more coronary segments. A trend to significance in correlation between presence of angiographic disease and signal in the vessel was observed (P 5 0.07; 80 vessels examined). A total of 7 patients with significant coronary artery disease had aortic 18 F-FDG uptake. Conclusion: In this retrospective study, we demonstrated the potential use of 18 F-FDG PET in imaging of inflammation in coronary arteries. The potential of 18 F-FDG PET is also being investigated in a prospective study.

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Section: Discussionmentioning

confidence: 98%

Imaging of Inflamed and Vulnerable Plaque in Coronary Arteries with ¹⁸F-FDG PET/CT in Patients with Suppression of Myocardial Uptake Using a Low-Carbohydrate, High-Fat Preparation

Wykrzykowska¹,

Lehman²,

Williams³

et al. 2009

J Nucl Med

248

151

View full text Add to dashboard Cite

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“…The utility of FDG PET to reliably measure aortic and carotid active plaque has been now demonstrated in several studies. 7,11,12 Coronary imaging has been limited, however, by the myocardial uptake. Variety of factors affects the myocardial FDG uptake.…”

Section: Discussionmentioning

confidence: 99%

Utility of high fat and low carbohydrate diet in suppressing myocardial FDG uptake

Harisankar

Mittal

Agrawal

et al. 2011

Journal of Nuclear Cardiology

122

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Consistent and significant myocardial FDG uptake suppression is possible in most patients using LCHFPP diet. The LCHFPP diet, if taken as per protocol, leads to consistent myocardial FDG uptake suppression to allow for adequate evaluation of the left coronary artery inflammation in nearly all the patients. LCHFPP diet is also significantly more efficacious than prolonged (>12 hours) fasting protocol in suppressing myocardial FDG uptake.

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“…The use of TBR has been justified by indicating that it was a blood-corrected uptake measurement (31,38). Yet, blood activity actually adds to wall activity due to the spatial blurring of the PET images (imperfect spatial resolution) and to the tissue fraction effect.…”

Section: Discussionmentioning

confidence: 99%

Variability and Uncertainty of ¹⁸F-FDG PET Imaging Protocols for Assessing Inflammation in Atherosclerosis: Suggestions for Improvement

Huet¹,

Burg²,

Guludec³

et al. 2015

J Nucl Med

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PET with 18 F-FDG shows promise for the evaluation of metabolic activities in atherosclerotic plaques. Although recommendations regarding the acquisition and measurement protocols to be used for 18 F-FDG PET imaging of atherosclerosis inflammation have been published, there is no consensus regarding the most appropriate protocols, and the image reconstruction approach has been especially overlooked. Given the small size of the targeted lesions, the reconstruction and measurement methods might strongly affect the results. We determined the differences in results due to the protocol variability and identified means of increasing the measurement reliability. Methods: An extensive literature search was performed to characterize the variability in atherosclerosis imaging and quantification protocols. Highly realistic simulations of atherosclerotic carotid lesions based on real patient data were designed to determine how the acquisition and processing protocol parameters affected the measured values. Results: In 49 articles, we identified 53 different acquisition protocols, 51 reconstruction protocols, and 46 quantification methods to characterize atherosclerotic lesions from 18 F-FDG PET images. The most important parameters affecting the measurement accuracy were the number of iterations used for reconstruction and the postfiltering applied to the reconstructed images, which could together make the measured standardized uptake values (SUVs) vary by a factor greater than 3. Image sampling, acquisition duration, and metrics used for the measurements also affected the results to a lesser extent (SUV varying by a factor of 1.3 at most). For an acceptable SUV variability, the lowest bias in SUV was observed using an 8-min acquisition per bed position; ordered-subset expectation maximization reconstruction with at least 120 maximum likelihood expectation maximization equivalent iterations, including a point spread function model using a 1 mm 3 voxel size; and no postfiltering. Because of the partial-volume effect, measurement bias remained greater than 60%. The use and limitations of the target-to-blood activity ratio metrics are also presented and discussed. Conclusion: 18 F-FDG PET protocol harmonization is needed in atherosclerosis imaging. Optimized protocols can significantly reduce the measurement errors in wall activity estimates, but PET systems with higher spatial resolution and advanced partial-volume corrections will be required to accurately assess plaque inflammation from 18 F-FDG PET.

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18F-FDG accumulation in atherosclerosis: use of CT and MR co-registration of thoracic and carotid arteries

Abstract: The results of our study suggest that not all atherosclerotic plaques show high FDG accumulation. FDG-PET studies of plaques with the use of fused images can potentially provide detailed information about atherosclerosis.

Cited by 44 publications

References 11 publications

Imaging of Inflamed and Vulnerable Plaque in Coronary Arteries with ¹⁸F-FDG PET/CT in Patients with Suppression of Myocardial Uptake Using a Low-Carbohydrate, High-Fat Preparation

Imaging of Inflamed and Vulnerable Plaque in Coronary Arteries with ¹⁸F-FDG PET/CT in Patients with Suppression of Myocardial Uptake Using a Low-Carbohydrate, High-Fat Preparation

Utility of high fat and low carbohydrate diet in suppressing myocardial FDG uptake

Variability and Uncertainty of ¹⁸F-FDG PET Imaging Protocols for Assessing Inflammation in Atherosclerosis: Suggestions for Improvement

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18F-FDG accumulation in atherosclerosis: use of CT and MR co-registration of thoracic and carotid arteries

Abstract: The results of our study suggest that not all atherosclerotic plaques show high FDG accumulation. FDG-PET studies of plaques with the use of fused images can potentially provide detailed information about atherosclerosis.

Cited by 44 publications

References 11 publications

Imaging of Inflamed and Vulnerable Plaque in Coronary Arteries with 18F-FDG PET/CT in Patients with Suppression of Myocardial Uptake Using a Low-Carbohydrate, High-Fat Preparation

Imaging of Inflamed and Vulnerable Plaque in Coronary Arteries with 18F-FDG PET/CT in Patients with Suppression of Myocardial Uptake Using a Low-Carbohydrate, High-Fat Preparation

Utility of high fat and low carbohydrate diet in suppressing myocardial FDG uptake

Variability and Uncertainty of 18F-FDG PET Imaging Protocols for Assessing Inflammation in Atherosclerosis: Suggestions for Improvement

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Imaging of Inflamed and Vulnerable Plaque in Coronary Arteries with ¹⁸F-FDG PET/CT in Patients with Suppression of Myocardial Uptake Using a Low-Carbohydrate, High-Fat Preparation

Imaging of Inflamed and Vulnerable Plaque in Coronary Arteries with ¹⁸F-FDG PET/CT in Patients with Suppression of Myocardial Uptake Using a Low-Carbohydrate, High-Fat Preparation

Variability and Uncertainty of ¹⁸F-FDG PET Imaging Protocols for Assessing Inflammation in Atherosclerosis: Suggestions for Improvement