Detection of Vulnerable Atherosclerotic Plaque and Prediction of Thrombosis Events in a Rabbit Model Using 18F-FDG -PET/CT

Abstract

BackgroundDetection of vulnerable plaques could be clinically significant in the prevention of cardiovascular events. We aimed to compare Fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in vulnerable and stable plaques, and investigate the feasibility of predicting thrombosis events using Positron Emission Tomography/Computed Tomography (PET/CT) angiography.MethodsAtherosclerosis was induced in 23 male New Zealand white rabbits. The rabbits underwent pharmacological triggering to induce thrombosis. A pre-triggered PET/CTA scan and a post-triggered PET/CTA scan were respectively performed. 18F-FDG uptake by the aorta was expressed as maximal standardized uptake value (SUVmax) and mean SUV (SUVmean). SUVs were measured on serial 7.5 mm arterial segments.ResultsThrombosis was identified in 15 of 23 rabbits. The pre-triggered SUVmean and SUVmax were 0.768±0.111 and 0.804±0.120, respectively, in the arterial segments with stable plaque, and 1.097±0.189 and 1.229±0.290, respectively, in the arterial segments with vulnerable plaque (P<0.001, respectively). The post-triggered SUVmean and SUVmax were 0.849±0.167 and 0.906±0.191, respectively in the arterial segments without thrombosis, and 1.152±0.258 and 1.294±0.313, respectively in the arterial segments with thrombosis (P<0.001, respectively). The values of SUVmean in the pre-triggered arterial segments were used to plot a receiver operating characteristic curve (ROC) for predicting thrombosis events. Area under the curve (AUC) was 0.898. Maximal sensitivity and specificity (75.4% and 88.5%, respectively) were obtained when SUVmean was 0.882.ConclusionsVulnerable and stable plaques can be distinguished by quantitative analysis of 18F-FDG uptake in the arterial segments in this rabbit model. PET/CT may be used for predicting thrombosis events and risk-stratification in patients with atherosclerotic disease.

Target identification for the diagnosis and intervention of vulnerable atherosclerotic plaques beyond 18F-fluorodeoxyglucose positron emission tomography imaging: promising tracers on the horizon

“…This model consists of placing a vascular (arterial) injury in rabbits receiving a hyperlipidaemic diet [52–54]. Of all preclinical models representative of the clinical situation, porcine models may be the best option for the investigation of atherosclerosis.…”

Detection of thrombosis in microvessels with indocyanine green videoangiography

“…Zhao et al investigated detection of thromboembolic event in an atherosclerotic rabbit model, induced by balloon injury within the abdominal aorta 24 . After additional deendothelialization of the aorta and pharmacological triggering PET/CT was conducted for the detection of thrombus formation 24 . After gross anatomical analysis and histopathological evaluation similar to our study, 15 of 23 thrombi were correctly diagnosed.…”

“…After gross anatomical analysis and histopathological evaluation similar to our study, 15 of 23 thrombi were correctly diagnosed. After adaption of the 18 F-FDG uptake based on the morphological findings a maximal sensitivity of 75.4% and specificity of 88.5% with a positive and negative predictive value of 53.5% and 98.5% was achieved 24 . In contrast to this method ICG videoangiography has no radiation and is easily performed in the intraoperative setting, since its function is based on simple fluorescence angiography.…”

Inflammation, Atherosclerosis, and Coronary Artery Disease: PET/CT for the Evaluation of Atherosclerosis and Inflammation

“…Overall, it has been shown that 18 F-FDG with PET/CT can be used to assess atherosclerotic plaques of varying compositions and throughout the different stages of the disease. 63 18 F-FDG has shown to be functional for understanding the underlying pathology involved in atherosclerosis.…”