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PET/CT Imaging of Inflammation and Calcification

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Cardiovascular Imaging

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Abstract

The biological processes within atherosclerotic plaques are known to be critically important to the progression and rupture of plaques. Among them inflammation is thought to be a key participant in all stages of atherosclerosis, from plaque initiation to progression and atherothrombosis. Accordingly, imaging of inflammation may provide important insights into the atherosclerotic milieu.

18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) imaging, originally developed as an imaging modality to evaluate oncologic processes, has evolved into a robust and reproducible modality for the quantification of arterial inflammation. Studies have shown that FDG uptake significantly correlates with arterial wall macrophage infiltration, high-risk morphological features of atherosclerotic plaques, expression of proinflammatory genes, and increased risk for future atherothrombotic events. Moreover, arterial FDG uptake is modifiable by anti-atherosclerotic treatments especially those with anti-inflammatory properties such as statins. Accordingly, FDG-PET/CT imaging is increasingly used as a surrogate imaging biomarker to monitor therapeutic efficacy of anti-atherosclerotic agents.

In this chapter, we review the basic cellular and molecular aspects of FDG-PET/CT imaging. Thereafter, we discuss the role of PET/CT imaging in noninvasive imaging of arterial inflammation, prediction of risk for progression of atherosclerosis, and risk assessment for subsequent atherothrombotic events. Furthermore, we discuss the utility of PET/CT imaging to evaluate the efficacy of new anti-atherosclerotic pharmacotherapies and review the results from recent imaging trials that employed PET/CT for this purpose. Lastly, we review the current state of the art and future directions for PET/CT imaging, with a review of coronary artery imaging, characterization of new targets, and recent improvements in camera and tracer technologies.

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Authors and Affiliations

  1. Cardiac MR PET CT Program, Department of Imaging and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA

    Hamed Emami MD & Ahmed Tawakol MD

  2. Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Ahmed Tawakol MD

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  1. Cardiovascular Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, Massachusetts, USA

    Elena Aikawa

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Emami, H., Tawakol, A. (2015). PET/CT Imaging of Inflammation and Calcification. In: Aikawa, E. (eds) Cardiovascular Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-09268-3_15

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