Quantitative assessment of the atherosclerotic burden of the aorta by combined FDG-PET and CT image analysis: a new concept

18F-FDG PET/CT for the quantification of inflammation in large carotid artery plaques

“…However, they admitted that many of the recommendations suffer from the absence of conclusive evidence. Compared to a solid tumor, the cells responsible for 18 F-FDG uptake in carotid artery plaques are generally fewer, more dispersed, and spread around parts of the circumference of a tubular vascular structure. 3,7 Consequently, limited spatial resolution of the PET scanner and blood background activity are of great concern.…”

“…Positron emission tomography (PET) imaging with 2-deoxy-2-( 18 F)-fluoro-D-glucose ( 18 F-FDG) of inflammation in atherosclerotic plaques has rapidly evolved since Rudd et al first reported 18 F-FDG accumulation in macrophage-rich areas of carotid artery plaques over a decade ago. 4 In contrast to oncology, 5 there is no consensus on methodological guidelines for 18 F-FDG PET/CT in atherosclerosis imaging.…”

“…4 In contrast to oncology, 5 there is no consensus on methodological guidelines for 18 F-FDG PET/CT in atherosclerosis imaging. A recent position paper from the Cardiovascular Committee of the European Association of Nuclear Medicine 6 proposed optimized and standardized protocols for the imaging and interpretation of 18 F-FDG PET scans in atherosclerosis. However, they admitted that many of the recommendations suffer from the absence of conclusive evidence.…”

“…Bural et al calculated the atherosclerotic burden of the aorta by multiplying the mean uptake values for each aorta segment with the vessel wall volume. 18 Subanalysis looking for the most metabolically active areas of a vessel segment have been used in therapy response studies. 16 The uptake values are either normalized to the blood background activity, 15,17,19,20 corrected for the background activity with subtraction 11 or not corrected for background activity.…”

Partial Volume Correction Strategies in PET

“…The most sophisticated PVC strategies rely on an adjunct coregistered structural image in which MR imaging plays a pivotal role because of the better contrast between the gray and white matter compared with CT [7][8][9][10]. Now, however, the use of correlated anatomic information provided by the CT component of dual-modality imaging systems (eg, PET/CT) makes it possible to perform accurate PVC in other organs and tissues including cardiovascular [11], atherosclerotic [12], and whole-body oncologic imaging [13,14].…”