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Optimizing 18F-FDG PET/CT imaging of vessel wall inflammation: the impact of 18F-FDG circulation time, injected dose, uptake parameters, and fasting blood glucose levels

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

18F-FDG PET is increasingly used for imaging of vessel wall inflammation. However, limited data are available on the impact of methodological variables, i.e. prescan fasting glucose, FDG circulation time and injected FDG dose, and of different FDG uptake parameters, in vascular FDG PET imaging.

Methods

Included in the study were 195 patients who underwent vascular FDG PET/CT of the aorta and the carotids. Arterial standardized uptake values (meanSUVmax), target-to-background ratios (meanTBRmax) and FDG blood-pool activity in the superior vena cava (SVC) and the jugular veins (JV) were quantified. Vascular FDG uptake values classified according to the tertiles of prescan fasting glucose levels, the FDG circulation time, and the injected FDG dose were compared using ANOVA. Multivariate regression analyses were performed to identify the potential impact of all variables described on the arterial and blood-pool FDG uptake.

Results

Tertile analyses revealed FDG circulation times of about 2.5 h and prescan glucose levels of less than 7.0 mmol/l, showing a favorable relationship between arterial and blood-pool FDG uptake. FDG circulation times showed negative associations with aortic meanSUVmax values as well as SVC and JV FDG blood-pool activity, but positive correlations with aortic and carotid meanTBRmax values. Prescan glucose levels were negatively associated with aortic and carotid meanTBRmax and carotid meanSUVmax values, but were positively correlated with SVC blood-pool uptake. The injected FDG dose failed to show any significant association with vascular FDG uptake.

Conclusion

FDG circulation times and prescan blood glucose levels significantly affect FDG uptake in the aortic and carotid walls and may bias the results of image interpretation in patients undergoing vascular FDG PET/CT. The injected FDG dose was less critical. Therefore, circulation times of about 2.5 h and prescan glucose levels less than 7.0 mmol/l should be preferred in this setting.

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Acknowledgment

The authors wish to thank Ash Rafique, RT, BS, CNMT, for his assistance with image acquisition. This work was partly supported by the NIHR Cambridge Biomedical Research Centre (J.H.F.R.). Partial support was provided by: NIH/NHLBI R01 HL071021 (Z.A.F.), NIH/NHLBI R01 HL078667 (Z.A.F and M.E.F.) and NIH/NCATS CTSA UL1TR000067 [Imaging Core] (Z.A.F.).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, P.O. Box 1234, New York, NY, 10029, USA

    Jan Bucerius, Venkatesh Mani, Colin Moncrieff & Zahi A. Fayad

  2. Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA

    Jan Bucerius, Venkatesh Mani, Colin Moncrieff & Zahi A. Fayad

  3. Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

    Jan Bucerius

  4. Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

    Jan Bucerius

  5. Department of Nuclear Medicine, University Hospital, RWTH Aachen, Aachen, Germany

    Jan Bucerius

  6. Department of Cardiology, Zena and Michael A. Weiner Cardiovascular Institute and Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, NY, USA

    Venkatesh Mani, Valentin Fuster, Michael E. Farkouh & Zahi A. Fayad

  7. Division of Nuclear Medicine, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA

    Josef Machac

  8. The Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain

    Valentin Fuster

  9. Cardiovascular Imaging Clinical Trials Unit, Mount Sinai School of Medicine, New York, NY, USA

    Michael E. Farkouh

  10. Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA

    Ahmed Tawakol

  11. Division of Cardiovascular Medicine, Cambridge University, Cambridge, UK

    James H. F. Rudd

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  1. Jan Bucerius
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  8. James H. F. Rudd
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Corresponding author

Correspondence to Zahi A. Fayad.

Additional information

J.H.F.R and Z.A.F contributed equally to this work and are joint senior authors.

Appendix

Appendix

Fig. 4
figure 4

Relationship between the classified prescan glucose values and arterial FDG uptake in the aorta and carotids. The FDG uptake is given as mean SUV (meanSUVmax). One-way ANOVA was performed to test for between-group differences. In the aorta, p = 0.216 for meanSUVmax; in the carotids, p = 0.170 for meanSUVmax. The data are presented as means ± standard deviation

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Fig. 5
figure 5

Relationship between injected FDG dose tertiles and arterial FDG uptake in the aorta and carotids. The FDG uptake is given as mean SUV (meanSUVmax). One-way ANOVA was performed to test for between-group differences. In the aorta, p = 0.166 for meanSUVmax; in the carotids, p = 0.229 for meanSUVmax. The data are presented as means ± standard deviation

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Fig. 6
figure 6

Relationship between FDG circulation time tertiles for the chest and neck scans and FDG uptake in the aorta and carotids. The FDG uptake is given as mean SUV (meanSUVmax). A one-way ANOVA was performed to test for between-group differences. In the aorta, p = 0.031 for meanSUVmax, and p = 0.034 for ≥ 78 – ≤111 min vs. >111 – < 145 min; in the carotids, p = 0.524 for meanSUVmax. The data are presented as means ± standard deviation

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Bucerius, J., Mani, V., Moncrieff, C. et al. Optimizing 18F-FDG PET/CT imaging of vessel wall inflammation: the impact of 18F-FDG circulation time, injected dose, uptake parameters, and fasting blood glucose levels. Eur J Nucl Med Mol Imaging 41, 369–383 (2014). https://doi.org/10.1007/s00259-013-2569-6

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  • DOI: https://doi.org/10.1007/s00259-013-2569-6

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