Annals of Nuclear Medicine

, Volume 28, Issue 6, pp 571–579 | Cite as

Higher reliability of 18F-FDG target background ratio compared to standardized uptake value in vulnerable carotid plaque detection: a pilot study

  • Artor Niccoli Asabella
  • Marco M. Ciccone
  • Francesca Cortese
  • Pietro Scicchitano
  • Michele Gesualdo
  • Annapaola Zito
  • Alessandra Di Palo
  • Domenico Angiletta
  • Guido Regina
  • Andrea Marzullo
  • Giuseppe Rubini
Original Article
First Online:
Received:
Accepted:

Abstract

Objective

To evaluate the role of [18F]-fluorodeoxyglucose positron emission tomography/computer tomography [18F-FDG PET/CT] comparing target background ratio (TBR) and standardized uptake value (SUV) with the histopathological inflammatory status of the carotid plaques.

Background

Vulnerable carotid plaques are the primary cause of acute cerebrovascular events. 18F-FDG PET/CT represents a morpho-functional technique able to identify the highly inflamed and most vulnerable carotid plaques. Several literature studies experimented this new method to identify vascular inflammation, but few have effectively compared PET/CT results with plaque histological data and no studies had directly compared TBR to SUV.

Methods

Thirty-two consecutive patients (20 men and 12 women, mean age 74 ± 8 years) undergoing carotid endarterectomy were enrolled and studied with carotid 18F-FDG PET/CT. Maximum and mean SUV and TBR were used to quantify 18F-FDG uptake while surgical specimens were analyzed by optical microscopy to identify inflamed carotid plaques, with evaluation of macrophages infiltration by mean of immunohistochemistry. On the basis of the presence of inflammation at the histological analysis, we divided population in two groups: group A (n = 12) patients with inflamed carotid plaques and group B (n = 20) patients with non-inflamed ones, then crossed and evaluated the histological data with 18F-FDG PET/CT findings.

Results

SUV max and SUV mean values resulted higher in group A (respectively, 2.14 ± 0.77 and 1.99 ± 0.68) than in group B (respectively, 1.79 ± 0.37 and 1.64 ± 0.34) without reaching a statistical significance (p = ns). TBR max and TBR mean values resulted higher in group A (respectively, 1.42 ± 0.32 and 1.34 ± 0.26) than in group B (respectively, 1.16 ± 0.19 and 1.03 ± 0.20) with a statistically significant differences between the two groups and carotid inflammation (respectively, p < 0.01 and p < 0.001).

Conclusion

TBR (max and mean values) is a more reliable parameter than SUV in identifying inflamed plaques. Although limited by the small population analyzed, our results suggest the important role of 18F-FDG PET/CT, using TBR, in identification of high-risk carotid atherosclerotic plaques.

Keywords

PET/CT Vulnerable carotid plaques Histology 
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Notes

Conflicts of interest

None declared.

References

  1. 1.
    Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125:188–97.PubMedCrossRefGoogle Scholar
  2. 2.
    Sitzer M, Trostdorf F. The unstable carotid stenosis: definition and biological processes. Hamostaseologie. 2003;23:61–6.PubMedGoogle Scholar
  3. 3.
    Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868–74.PubMedCrossRefGoogle Scholar
  4. 4.
    Chaturvedi S, Bruno A, Feasby T, Holloway R, Benavente O, Cohen SN, et al. Carotid endarterectomy—an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005;65:794–801.PubMedCrossRefGoogle Scholar
  5. 5.
    Tawakol A, Migrino RQ, Hoffmann U, Abbara S, Houser S, Gerwitz H, et al. Noninvasive in vivo measurement of vascular inflammation with F-18 fluorodeoxyglucose positron emission tomography. J Nucl Cardiol. 2005;12:294–301.PubMedCrossRefGoogle Scholar
  6. 6.
    de Vries Wallis BM, van Dam GM, Tio RA, Hillebrands JL, Slart RH, Zeebregts CJ. Current imaging modalities to visualize vulnerability within the atherosclerotic carotid plaque. J Vasc Surg. 2008;48:1620–9.CrossRefGoogle Scholar
  7. 7.
    Meerwaldt R, Slart RH, van Dam GM, Luijckx GJ, Tio RA, Zeebregts CJ. PET/SPECT imaging: from carotid vulnerability to brain viability. Eur J Radiol. 2010;74:104–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Tahara N, Kai H, Nakaura H, Mizoguchi M, Ishibashi M, Kaida H, et al. The prevalence of inflammation in carotid atherosclerosis: analysis with fluorodeoxyglucose-positron emission tomography. Eur Heart J. 2007;28:2243–8.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedGoogle Scholar
  10. 10.
    Riou LM, Broisat A, Dimastromatteo J, Pons G, Fagret D, Ghezzi C. Pre-clinical and clinical evaluation of nuclear tracers for the molecular imaging of vulnerable atherosclerosis: an overview. Curr Med Chem. 2009;16:1499–511.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Figueroa AL, Subramanian SS, Cury RC, Truong QA, Gardecki JA, Tearney GJ, et al. Distribution of inflammation within carotid atherosclerotic plaques with high-risk morphological features: a comparison between positron emission tomography activity, plaque morphology, and histopathology. Circ Cardiovasc Imaging. 2012;5:69–77.PubMedCrossRefGoogle Scholar
  12. 12.
    Eckstein HH. Evidence-based management of carotid stenosis: recommendations from international guidelines. J Cardiovasc Surg (Torino). 2012;53:S3–13.Google Scholar
  13. 13.
    Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens. 2007;25:1751–62.PubMedCrossRefGoogle Scholar
  14. 14.
    American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33:S62–9.PubMedCentralCrossRefGoogle Scholar
  15. 15.
    National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation. 2002;106:3143–421.Google Scholar
  16. 16.
    Martínez JA, Kearney JM, Kafatos A, Paquet S, Martínez-González MA. Variables independently associated with self-reported obesity in the European Union. Public Health Nutr. 1999;2:125–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Silberberg JS, Wlodarczyk J, Fryer J, Robertson R, Hensley MJ. Risk associated with various definitions of family history of coronary heart disease. The Newcastle Family History Study II. Am J Epidemiol. 1998;147:1133–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, et al. Mannheim carotid intima-media thickness consensus (2004–2006). Cerebrovasc Dis. 2007;23:75–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation. 1986;74:1399–406.PubMedCrossRefGoogle Scholar
  20. 20.
    Arnold JA, Modaresi KB, Thomas N, Taylor PR, Padayachee TS. Carotid plaque characterization by duplex scanning: observer error may undermine current clinical trials. Stroke. 1999;30:61–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Kim TY, Choi JB, Kim KH, Kim MH, Shin BS, Park HK. Routine shunting is safe and reliable for cerebral perfusion during carotid endarterectomy in symptomatic carotid stenosis. Korean J Thorac Cardiovasc Surg. 2012;45:95–100.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Hellings WE, Pasterkamp G, Vollebregt A, Seldenrijk CA, De Vries JP, Velema E, et al. Intraobserver and interobserver variability and spatial differences in histologic examination of carotid endarterectomy specimens. J Vasc Surg. 2007;46:1147–54.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    Tahara N, Kai H, Ishibashi M, Nakaura H, Kaida H, Baba K, et al. Simvastatin attenuates plaque inflammation: evaluation by fluorodeoxyglucose positron emission tomography. J Am Coll Cardiol. 2006;48:1825–31.PubMedCrossRefGoogle Scholar
  26. 26.
    Chen W, Dilsizian V. (18)F-fluorodeoxyglucose PET imaging of coronary atherosclerosis and plaque inflammation. Curr Cardiol Rep. 2010;12:179–84.PubMedCrossRefGoogle Scholar
  27. 27.
    Folco EJ, Sheikine Y, Rocha VZ, Christen T, Shvartz E, Sukhova GK, et al. Hypoxia but not inflammation augments glucose uptake in human macrophages. J Am Coll Cardiol. 2011;58:603–14.PubMedCrossRefGoogle Scholar
  28. 28.
    Sheikine Y, Akram K. FDG-PET imaging of atherosclerosis: Do we know what we see? Atherosclerosis. 2010;211:371–80.PubMedCrossRefGoogle Scholar
  29. 29.
    Graebe M, Pedersen SF, Højgaard L, Kjaer A, Sillesen H. 18FDG PET and ultrasound echolucency in carotid artery plaques. JACC Cardiovasc Imaging. 2010;3:289–95.PubMedCrossRefGoogle Scholar
  30. 30.
    Martinet W, Schrijvers DM, De Meyer GR. Molecular and cellular mechanisms of macrophage survival in atherosclerosis. Basic Res Cardiol. 2012;107:297.PubMedCrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    Shepherd PR, Kahn BB. Glucose transporters and insulin action implications for insulin resistance and diabetes mellitus. N Engl J Med. 1999;341:248–57.PubMedCrossRefGoogle Scholar
  33. 33.
    Wahl RL, Henry CA, Ethier SP. Serum glucose: effects on tumor and normal tissue accumulation of 2-[F-18]-fluoro-2-deoxy-d-glucose in rodents with mammary carcinoma. Radiology. 1992;183:643–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Deichen JT, Prante O, Gack M, Schmiedehause K, Kuwert T. Uptake of [(18)F]fluorodeoxyglucose in human monocyte-macrophages in vitro. Eur J Nucl Med Mol Imaging. 2003;30:267–73.PubMedCrossRefGoogle Scholar
  35. 35.
    Niccoli Asabella A, Iuele FI, Merenda N, Pisani AR, Notaristefano A, Rubini G. 18F-FDG PET/CT diabetes and hyperglycaemia. Nucl Med Rev Cent East Eur. 2013;16(2):57–61.PubMedCrossRefGoogle Scholar
  36. 36.
    Rudd JH, Myers KS, Bansilal S, Machac J, Woodward M, Fuster V, et al. Relationships among regional arterial inflammation, calcification, risk factors, and biomarkers a prospective fluorodeoxyglucose positron-emission tomography/computed tomography imaging study. Circ Cardiovasc Imaging. 2009;2:107–15.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Derlin T, Wisotzki C, Richter U, Apostolova I, Bannas P, Weber C, et al. In vivo imaging of mineral deposition in carotid plaque using 18F-sodium fluoride. J Nucl Med. 2011;52:362–8.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2014

Authors and Affiliations

  • Artor Niccoli Asabella
    • 1
  • Marco M. Ciccone
    • 2
  • Francesca Cortese
    • 2
  • Pietro Scicchitano
    • 2
  • Michele Gesualdo
    • 2
  • Annapaola Zito
    • 2
  • Alessandra Di Palo
    • 1
  • Domenico Angiletta
    • 3
  • Guido Regina
    • 3
  • Andrea Marzullo
    • 4
  • Giuseppe Rubini
    • 1
  1. 1.Nuclear Medicine Unit, D.I.M.University of Bari “Aldo Moro”BariItaly
  2. 2.Cardiovascular Diseases Section, D.E.T.O.University of Bari “Aldo Moro”BariItaly
  3. 3.Vascular Surgery Unit, D.E.T.O.University of Bari “Aldo Moro”BariItaly
  4. 4.Pathological Anatomy Unit, D.E.T.O.University of Bari “Aldo Moro”BariItaly

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