Direct relationship between cell density and FDG uptake in asymptomatic aortic aneurysm close to surgical threshold: an in vivo and in vitro study

Marini, Cecilia; Morbelli, Silvia; Armonino, Riccardo; Spinella, Giovanni; Riondato, Mattia; Massollo, Michela; Sarocchi, Francesca; Pane, Bianca; Augeri, C; Abete, Luca; Ghigliotti, G; Palmieri, Daniela; Fiz, Francesco; Cittadini, Giuseppe; Fulcheri, Ezio; Palombo, Domenico; Sambuceti, Gianmario

doi:10.1007/s00259-011-1955-1

Cited by 29 publications

(29 citation statements)

References 30 publications

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“…Recent histopathologic studies showed that the low level of 18 F-FDG uptake of asymptomatic AAA reflects the metabolic activity of a small number of cells present within arterial walls (13), especially in fibrotic and necrotic regions (8). It is noteworthy that these cells include not only inflammatory cells but also smooth muscle cells exhibiting a sustained increase in glucose uptake, especially when stimulated and chronically exposed to inflammatory cytokines, a common situation within atherosclerotic walls (21,22).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, in the atherosclerotic walls of most asymptomatic AAA, the overall number of cells able to entrap 18 F-FDG is considerably reduced, leading to a global low level of 18 F-FDG uptake (8,13,20). These data imply that, in such cases, chronic inflammation would not be sufficiently active to result in increased glucose metabolism detectable by PET cameras (20).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, an abnormally low level of 18 F-FDG uptake is commonly documented for uncomplicated AAA (12,13), presumably because of a decrease in cellular density (8,13). Furthermore, the level of uptake may be even lower in AAA that are more likely to exhibit a subsequent enhancement in maximal diameter (14).…”

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confidence: 99%

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Evidence of Cyclic Changes in the Metabolism of Abdominal Aortic Aneurysms During Growth Phases: ¹⁸F-FDG PET Sequential Observational Study

Morel¹,

Mandry

Micard

et al. 2015

J Nucl Med

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The rates of growth of medically treated abdominal aortic aneurysms (AAA) are difficult to determine, and relationships with parietal inflammation and with metabolic parameters from 18 F-FDG PET remain unclear. This 18 F-FDG PET sequential observational study was aimed at analyzing the metabolic changes accompanying the growth phases of medically treated AAA. Methods: Thirty-nine patients (37 men; age [mean ± SD], 71 ± 12 y) exhibiting small and medically treated AAA (maximal diameter, 46 ± 3 mm) underwent 18 F-FDG PET and CT angiography at baseline and 9 mo later. Clinical and imaging parameter correlates of the 9-mo increase in maximal diameter were investigated; these included 18 F-FDG maximal standardized uptake values (SUV max ) averaged for slices encompassing the AAA volume. Results: Of the 39 patients, 9 (23%) had a significant ($2.5 mm) increase in maximal diameter at 9 mo, whereas the remaining 30 did not. The patients with an increase in maximal diameter at 9 mo exhibited lower SUV max within the AAA at baseline than patients who did not have such an increase (1.80 ± 0.45 vs. 2.21 ± 0.52; P 5 0.04); they also displayed a trend toward greater changes in SUV max at 9 mo (difference between 9 mo and baseline: 10.40 ± 0.85 vs. −0.06 ± 0.57; P 5 0.07). Similar levels were ultimately reached in both groups at 9 mo (2.20 ± 0.83 and 2.15 ± 0.66). SUV max was a significant, yet modest, baseline predictor of the absolute change in maximal diameter during follow-up (P 5 0.049). Conclusion: The enhancement in the maximal diameter of small AAA was preceded by a stage with a low level of 18 F-FDG uptake, but this low level of uptake was no longer documented after the growth phases, suggesting a pattern of cyclic metabolic changes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evidence of Cyclic Changes in the Metabolism of Abdominal Aortic Aneurysms During Growth Phases: ¹⁸F-FDG PET Sequential Observational Study

Morel¹,

Mandry

Micard

et al. 2015

J Nucl Med

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“…In fact, FDG signal in the aneurysmal aorta was lower than in controls [74]. Further work suggested that this low uptake may reflect lower cell density in the aneurysmal wall compared with normal regions [75].…”

Section: F-fdg Pet In Abdominal Aortic Aneurysm Imagingmentioning

confidence: 99%

Advances in imaging vascular inflammation

Rajani

Joshi

Tarkin

et al. 2013

Clin Transl Imaging

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Inflammation is central to the pathogenesis of many vascular diseases. Despite an understanding of the natural history, predicting progression and acute complications remains an important clinical challenge in both atherosclerosis and aortic aneurysms. Current means of monitoring rely mainly on structural information, such as the extent of luminal stenosis on coronary angiography or maximum aneurysm diameter on ultrasonography. Although often useful in making clinical decisions about intervention, such measures do not always correlate well with the risk of acute complications. As an example, the degree of luminal obstruction correlates poorly with the risk of future coronary plaque rupture and, similarly, aneurysm size does not account entirely for the subsequent rate of expansion and risk of rupture. It might be possible to improve risk prediction using imaging modalities that focus on the underlying disease processes rather than their consequences. This article reviews non-invasive imaging techniques that track inflammation within the arterial wall as applied to atherosclerosis and abdominal aneurysms. These all aim to improve risk prediction, to highlight the underlying pathology non-invasively and to permit the testing of new therapeutic agents against vascular disease.

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“…In smaller, asymptomatic aneurysms, below the cutoff for surgery, there is no histologic validation of the 18 F-FDG signal, so its relevance can be extrapolated only from the studies mentioned above. Several authors (30)(31)(32) have noted low 18 F-FDG uptake in this group. This low uptake could reflect the true pathologic state-that is, inflammation is largely absent-or it might simply highlight the limitations of PET in this situation.…”

Section: Role Of Pet Imaging In Aneurysm Diseasementioning

confidence: 99%

Predicting Aortic Aneurysm Expansion by PET

2015

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Direct relationship between cell density and FDG uptake in asymptomatic aortic aneurysm close to surgical threshold: an in vivo and in vitro study

Abstract: The loss of tissue structure and the marked decrease in cell density account for the low prevalence of positive findings at FDG PET imaging, at least in asymptomatic patients bearing AAAs whose diameter is close to surgical indication.

Cited by 29 publications

References 30 publications

Evidence of Cyclic Changes in the Metabolism of Abdominal Aortic Aneurysms During Growth Phases: ¹⁸F-FDG PET Sequential Observational Study

Evidence of Cyclic Changes in the Metabolism of Abdominal Aortic Aneurysms During Growth Phases: ¹⁸F-FDG PET Sequential Observational Study

Advances in imaging vascular inflammation

Predicting Aortic Aneurysm Expansion by PET

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Direct relationship between cell density and FDG uptake in asymptomatic aortic aneurysm close to surgical threshold: an in vivo and in vitro study

Abstract: The loss of tissue structure and the marked decrease in cell density account for the low prevalence of positive findings at FDG PET imaging, at least in asymptomatic patients bearing AAAs whose diameter is close to surgical indication.

Cited by 29 publications

References 30 publications

Evidence of Cyclic Changes in the Metabolism of Abdominal Aortic Aneurysms During Growth Phases: 18F-FDG PET Sequential Observational Study

Evidence of Cyclic Changes in the Metabolism of Abdominal Aortic Aneurysms During Growth Phases: 18F-FDG PET Sequential Observational Study

Advances in imaging vascular inflammation

Predicting Aortic Aneurysm Expansion by PET

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Resources

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Evidence of Cyclic Changes in the Metabolism of Abdominal Aortic Aneurysms During Growth Phases: ¹⁸F-FDG PET Sequential Observational Study

Evidence of Cyclic Changes in the Metabolism of Abdominal Aortic Aneurysms During Growth Phases: ¹⁸F-FDG PET Sequential Observational Study