Skip to main content

Advertisement

SpringerLink
Log in

18F-FDG PET/CT imaging factors that predict ischaemic stroke in cancer patients

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

18F-FDG PET/CT can acquire both anatomical and functional images in a single session. We investigated which factors of 18F-FDG PET/CT imaging have potential as biomarkers for an increased risk of ischaemic stroke in cancer patients.

Methods

From among cancer patients presenting with various neurological symptoms and hemiparesis, 134 were selected as eligible for this retrospective analysis. A new infarct lesion on brain MRI within 1 year of FDG PET/CT defined future ischaemic stroke. The target-to-background ratio (TBR) of each arterial segment was used to define arterial inflammation on PET imaging. Abdominal obesity was defined in terms of the area and proportion of visceral adipose tissue (VAT), subcutaneous adipose tissue and total adipose tissue (TAT) on a single CT slice at the umbilical level.

Results

Ischaemic stroke confirmed by MRI occurred in 30 patients. Patients with stroke had higher TBRs in the carotid arteries and abdominal aorta (P < 0.001) and a higher VAT proportion (P = 0.021) and TAT proportion (P = 0.041) than patients without stroke. Multiple logistic regression analysis showed that TBRs of the carotid arteries and abdominal aorta, VAT and TAT proportions, and the presence of a metabolically active tumour were significantly associated with future ischaemic stroke. Combining PET and CT variables improved the power for predicting future ischaemic stroke.

Conclusion

Our findings suggest that arterial FDG uptake and hypermetabolic malignancy on PET and the VAT proportion on CT could be independent predictors of future ischaemic stroke in patients with cancer and could identify those patients who would benefit from medical treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cestari DM, Weine DM, Panageas KS, Segal AZ, DeAngelis LM. Stroke in patients with cancer: incidence and etiology. Neurology. 2004;62:2025–30.

    Article  CAS  PubMed  Google Scholar 

  2. Taccone FS, Jeangette SM, Blecic SA. First-ever stroke as initial presentation of systemic cancer. J Stroke Cerebrovasc Dis. 2008;17:169–74.

    Article  PubMed  Google Scholar 

  3. Rominger A, Saam T, Wolpers S, Cyran CC, Schmidt M, Foerster S, et al. 18F-FDG PET/CT identifies patients at risk for future vascular events in an otherwise asymptomatic cohort with neoplastic disease. J Nucl Med. 2009;50:1611–20.

    Article  PubMed  Google Scholar 

  4. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39–48.

    Article  PubMed  Google Scholar 

  5. Pou KM, Massaro JM, Hoffmann U, Vasan RS, Maurovich-Horvat P, Larson MG, et al. Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study. Circulation. 2007;116:1234–41.

    Article  CAS  PubMed  Google Scholar 

  6. Muuronen AT, Taina M, Hedman M, Marttila J, Kuusisto J, Onatsu J, et al. Increased visceral adipose tissue as a potential risk factor in patients with embolic stroke of undetermined source (ESUS). PLoS One. 2015;10, e0120598.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rordorf G, Koroshetz WJ, Copen WA, Cramer SC, Schaefer PW, Budzik Jr RF, et al. Regional ischemia and ischemic injury in patients with acute middle cerebral artery stroke as defined by early diffusion-weighted and perfusion-weighted MRI. Stroke. 1998;29:939–43.

    Article  CAS  PubMed  Google Scholar 

  8. Whitworth JA, World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21:1983–92.

    Article  PubMed  Google Scholar 

  9. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33 Suppl 1:S62–9.

    Article  PubMed Central  Google Scholar 

  10. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol. 1987;149:351–6.

    Article  CAS  PubMed  Google Scholar 

  11. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78.

    Article  PubMed  Google Scholar 

  12. Grandpierre S, Desandes E, Meneroux B, Djaballah W, Mandry D, Netter F, et al. Arterial foci of F-18 fluorodeoxyglucose are associated with an enhanced risk of subsequent ischemic stroke in cancer patients: a case-control pilot study. Clin Nucl Med. 2011;36:85–90.

    Article  PubMed  Google Scholar 

  13. Rudd JH, Myers KS, Bansilal S, Machac J, Pinto CA, Tong C, et al. Atherosclerosis inflammation imaging with 18F-FDG PET: carotid, iliac, and femoral uptake reproducibility, quantification methods, and recommendations. J Nucl Med. 2008;49:871–8.

    Article  PubMed  Google Scholar 

  14. Rudd JH, Myers KS, Bansilal S, Machac J, Rafique A, Farkouh M, et al. (18)Fluorodeoxyglucose positron emission tomography imaging of atherosclerotic plaque inflammation is highly reproducible: implications for atherosclerosis therapy trials. J Am Coll Cardiol. 2007;50:892–6.

    Article  PubMed  Google Scholar 

  15. Imai A, Komatsu S, Ohara T, Kamata T, Yoshida J, Miyaji K, et al. Visceral abdominal fat accumulation predicts the progression of noncalcified coronary plaque. Atherosclerosis. 2012;222:524–9.

    Article  CAS  PubMed  Google Scholar 

  16. Muller HF, Viaccoz A, Fisch L, Bonvin C, Lovblad KO, Ratib O, et al. 18FDG-PET-CT: an imaging biomarker of high-risk carotid plaques. Correlation to symptoms and microembolic signals. Stroke. 2014;45:3561–6.

    Article  PubMed  Google Scholar 

  17. Chroinin DN, Marnane M, Akijian L, Merwick A, Fallon E, Horgan G, et al. Serum lipids associated with inflammation-related PET-FDG uptake in symptomatic carotid plaque. Neurology. 2014;82:1693–9.

    Article  CAS  PubMed  Google Scholar 

  18. Ogawa M, Ishino S, Mukai T, Asano D, Teramoto N, Watabe H, et al. (18)F-FDG accumulation in atherosclerotic plaques: immunohistochemical and PET imaging study. J Nucl Med. 2004;45:1245–50.

    CAS  PubMed  Google Scholar 

  19. Tawakol A, Migrino RQ, Bashian GG, Bedri S, Vermylen D, Cury RC, et al. In vivo 18F-fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflammation in patients. J Am Coll Cardiol. 2006;48:1818–24.

    Article  PubMed  Google Scholar 

  20. Bang OY, Seok JM, Kim SG, Hong JM, Kim HY, Lee J, et al. Ischemic stroke and cancer: stroke severely impacts cancer patients, while cancer increases the number of strokes. J Clin Neurol. 2011;7:53–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Karcher HS, Holzwarth R, Mueller HP, Ludolph AC, Huber R, Kassubek J, et al. Body fat distribution as a risk factor for cerebrovascular disease: an MRI-based body fat quantification study. Cerebrovasc Dis. 2013;35:341–8.

    Article  PubMed  Google Scholar 

  22. Lear SA, Humphries KH, Kohli S, Frohlich JJ, Birmingham CL, Mancini GB. Visceral adipose tissue, a potential risk factor for carotid atherosclerosis: results of the Multicultural Community Health Assessment Trial (M-CHAT). Stroke. 2007;38:2422–9.

    Article  PubMed  Google Scholar 

  23. Saam T, Rominger A, Wolpers S, Nikolaou K, Rist C, Greif M, et al. Association of inflammation of the left anterior descending coronary artery with cardiovascular risk factors, plaque burden and pericardial fat volume: a PET/CT study. Eur J Nucl Med Mol Imaging. 2010;37:1203–12.

    Article  PubMed  Google Scholar 

  24. Yamashiro K, Tanaka R, Tanaka Y, Miyamoto N, Shimada Y, Ueno Y, et al. Visceral fat accumulation is associated with cerebral small vessel disease. Eur J Neurol. 2014;21:667–73.

    Article  CAS  PubMed  Google Scholar 

  25. Alessi MC, Peiretti F, Morange P, Henry M, Nalbone G, Juhan-Vague I. Production of plasminogen activator inhibitor 1 by human adipose tissue: possible link between visceral fat accumulation and vascular disease. Diabetes. 1997;46:860–7.

    Article  CAS  PubMed  Google Scholar 

  26. Fantuzzi G, Mazzone T. Adipose tissue and atherosclerosis: exploring the connection. Arterioscler Thromb Vasc Biol. 2007;27:996–1003.

    Article  CAS  PubMed  Google Scholar 

  27. Starr ME, Hu Y, Stromberg AJ, Carmical JR, Wood TG, Evers BM, et al. Gene expression profile of mouse white adipose tissue during inflammatory stress: age-dependent upregulation of major procoagulant factors. Aging Cell. 2013;12:194–206.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Kwee RM, Truijman MT, Mess WH, Teule GJ, ter Berg JW, Franke CL, et al. Potential of integrated [18F] fluorodeoxyglucose positron-emission tomography/CT in identifying vulnerable carotid plaques. AJNR Am J Neuroradiol. 2011;32:950–4.

    Article  CAS  PubMed  Google Scholar 

  29. Izquierdo-Garcia D, Davies JR, Graves MJ, Rudd JH, Gillard JH, Weissberg PL, et al. Comparison of methods for magnetic resonance-guided [18-F]fluorodeoxyglucose positron emission tomography in human carotid arteries: reproducibility, partial volume correction, and correlation between methods. Stroke. 2009;40:86–93.

    Article  PubMed  Google Scholar 

  30. Maher V, O’Dowd M, Carey M, Markham C, Byrne A, Hand E, et al. Association of central obesity with early carotid intima-media thickening is independent of that from other risk factors. Int J Obes (Lond). 2009;33:136–43.

    Article  CAS  Google Scholar 

  31. Rudd JH, Warburton EA, Fryer TD, Jones HA, Clark JC, Antoun N, et al. Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation. 2002;105:2708–11.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea

    Jahae Kim & Ho-Chun Song

  2. Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea

    Kang-Ho Choi, Joon-Tae Kim, Man-Seok Park & Ki-Hyun Cho

  3. Department of Neurology, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea

    Kang-Ho Choi

Authors
  1. Jahae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kang-Ho Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ho-Chun Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joon-Tae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Man-Seok Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ki-Hyun Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kang-Ho Choi.

Ethics declarations

Funding

This study was supported by a grant from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI12C1631, Choi K.H.).

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J., Choi, KH., Song, HC. et al. 18F-FDG PET/CT imaging factors that predict ischaemic stroke in cancer patients. Eur J Nucl Med Mol Imaging 43, 2228–2235 (2016). https://doi.org/10.1007/s00259-016-3460-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-016-3460-z

Keywords

Search

Navigation