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PET/CTA detection of muscle inflammation related to cholesterol crystal emboli without arterial obstruction

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

PET/CTA was used to evaluate the effect of cholesterol crystal emboli (CCE) on muscle injury. Cholesterol crystals (CCs) released during plaque rupture travel downstream and lodge in muscle triggering inflammation and tissue injury.

Methods

Thigh muscles in three groups of rabbits (n = 22) were studied after intra-arterial injection of CCs, Group I (n = 10); polystyrene microspheres, Group II (n = 5); or normal saline, Group III (n = 7). After 48 hours, muscle inflammation and injury were measured by fluorodeoxy-glucose uptake using PET/CTA, serum tissue factor (TF), and creatinine phosphokinase (CPK). Macrophages were stained with RAM11 and CCs with Bodipy.

Results

SUVmax of thigh muscles was greater for Group I vs Group II and III (0.40 ± 0.16 vs 0.21 ± 0.11, P = .038 and 0.23 ± 0.06, P = .036). CPK levels rose significantly in Group I vs Group II and III (6.7 ± 6.0 vs 0.6 ± 0.4, P = .007 and 0.9 ± 0.4 mg·dL−1, P = .023). No arterial thrombosis was detected by CTA or histology of embolized arteries and TF did not rise significantly. There were extensive macrophage infiltrates surrounding muscle necrosis in Group I only.

Conclusions

Cholesterol crystal emboli triggered muscle inflammation and necrosis with an intact circulation. PET/CTA may help in the early detection of inflammation caused by CCs.

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Abbreviations

CCs:

Cholesterol crystals

CCE:

Cholesterol crystal embolization

CPK:

Creatinine phosphokinase

PET/CTA:

Positron emission tomography and computed tomography angiography

LM:

Light microscopy

SUVmax:

Maximum standardized uptake values

MS:

Microspheres

SAL:

Saline

SEM:

Scanning electron microscopy

TF:

Serum tissue factor

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Acknowledgments

The authors thank Ruiping Huang, Tracy Needham, Jeremy Williams, and Michelle Bengel for technical support. We also thank Melinda Frame, PhD, Center for Advanced Microscopy and Amy Porter, HT, QIHC, Investigative Histopathology Laboratory, Michigan State University, East Lansing, MI. Support was provided in part from Michigan State University and Edward W. Sparrow Hospital, Lansing, MI.

Disclosures

Dr. G.S. Abela is a recipient of grants from Merck and speaker for Amgen and Daiichi Sankyo. Dr. K. Berger is recipient of grants from Merck and Janssen. He is a speaker for Cardinal Health and Educational Symposia. For all remaining authors, conflict of interest is none declared.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, MI, USA

    M. Hassan Pervaiz MD, Sridevi Durga MD, Abed Janoudi PhD & George S. Abela MD, MSc

  2. Department of Radiology, Michigan State University, East Lansing, MI, USA

    Kevin Berger MD

  3. Division of Pathology, Department of Physiology, Michigan State University, East Lansing, MI, USA

    George S. Abela MD, MSc

  4. Michigan State University, B208 Clinical Center, East Lansing, MI, 48824, USA

    George S. Abela MD, MSc

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  1. M. Hassan Pervaiz MD
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  2. Sridevi Durga MD
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  3. Abed Janoudi PhD
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  4. Kevin Berger MD
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  5. George S. Abela MD, MSc
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Corresponding author

Correspondence to George S. Abela MD, MSc.

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Pervaiz, M.H., Durga, S., Janoudi, A. et al. PET/CTA detection of muscle inflammation related to cholesterol crystal emboli without arterial obstruction. J. Nucl. Cardiol. 25, 433–440 (2018). https://doi.org/10.1007/s12350-017-0826-y

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  • DOI: https://doi.org/10.1007/s12350-017-0826-y

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