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Fluorine-18 fluorodeoxyglucose positron emission tomography-based textural features for prediction of event prone carotid atherosclerotic plaques

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

Abstract

Background

Texture analysis has been increasingly used in the field of positron emission tomography (PET)/computed tomography (CT) imaging with Fluorine-18 fluorodeoxyglucose (18F-FDG), aiming at assessing tumor heterogeneity. The purpose of the present study is to examine the feasibility of performing texture analysis in carotid arteries, investigate the value of textural features as predictors of potential plaque vulnerability using as reference standards histological and immunohistochemical data and compare their performance with conventional uptake measurements.

Methods

67 different 18F-FDG PET-based textural features were extracted from carotid images of 21 patients with high-grade carotid stenosis undergoing endarterectomy. To identify the more reliable predictors, univariate logistic regression analysis was performed. The accuracy was satisfactory in case of an Area Under the Receiver Operating Characteristic (ROC) curve (AUC) ≥ 0.80.

Results

First measure of information correlation (AUC = 0.87, P < 0.001), large zone low gray level emphasis (AUC = 0.87, P < 0.001), and normalized run length non-uniformity (AUC = 0.84, P < 0.001) were the most optimal textural features for identifying characteristics of plaque vulnerability based on histological analysis. Addition of textural features to target-to-background ratio (TBR) (AUC = 0.74, P = 0.031) resulted in an AUC = 0.92 (P < 0.001), however, this did not reach statistical significance (Pdiff = 0.09). Intensity histogram standard deviation (AUC = 0.87, P < 0.001) and joint variance (AUC = 0.81, P = 0.001) were the most efficient features for signal differential in relation to immunohistochemical findings and provided incremental value compared to TBR (Pdiff = 0.02).

Conclusion

Texture analysis can be applied in 18F-FDG PET carotid imaging providing valuable information for plaque characterization.

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Abbreviations

18F-FDG:

Fluorine-18 fluorodeoxyglucose

PET:

Positron emission tomography

CT:

Computed tomography

ROI:

Region of interest

TBR:

Target-to-background ratio

info.correlation1GLCM :

First measure of information correlation

rlnuGLRLM :

Run length non-uniformity

lzlgeGLSZM :

Large zone low gray level emphasis

SDIH :

Intensity histogram standard deviation

varianceGLCM :

Joint variance

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Disclosures

Kafouris P, Koutagiar I, Georgakopoulos A, Spyrou G, Visvikis D and Anagnostopoulos C declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece

    Pavlos P. Kafouris MSc

  2. Experimental Surgery, Clinical and Translational Research Centre, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St., 11527, Athens, Greece

    Pavlos P. Kafouris MSc, Alexandros T. Georgakopoulos MD & Constantinos D. Anagnostopoulos MD, PhD

  3. First Department of Cardiology, Hippokration Hospital, Athens, Greece

    Iosif P. Koutagiar MD, PhD

  4. The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus

    George M. Spyrou PhD

  5. Cyprus School of Molecular Medicine, Nicosia, Cyprus

    George M. Spyrou PhD

  6. LaTIM, INSERM, UMR 1101, University Brest, Brest, France

    Dimitrios Visvikis PhD

Authors
  1. Pavlos P. Kafouris MSc
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  2. Iosif P. Koutagiar MD, PhD
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  3. Alexandros T. Georgakopoulos MD
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  5. Dimitrios Visvikis PhD
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Correspondence to Constantinos D. Anagnostopoulos MD, PhD.

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Funding

The study was supported by the project “The Greek research infrastructure for personalized medicine (pMED-GR)(MIS 5002802)”, which is implemented under the Action “Reinforcement of the Research and Innovation Infrastructure”, funded by the Operational Program “Competitiveness, Entrepreneurship and Innovation” (NSRF 2014-2020) and co-financed by Greece and the European Union (European Regional Development Fund). George Spyrou is funded by the European Commission Research Executive Agency Grant BIORISE (No. 669026), under the Spreading Excellence, Widening Participation, Science with and for Society Framework. Pavlos Kafouris’ doctoral thesis is co-financed by Greece and the European Union (European Social Fund (ESF)) through the Operational Program “Human Resources Development, Education and Lifelong Learning” in the context of the project “Strengthening Human Resources Research Potential via Doctorate Research” (OPS-5003404), implemented by the State Scholarships Foundation (ΙΚΥ).

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Kafouris, P.P., Koutagiar, I.P., Georgakopoulos, A.T. et al. Fluorine-18 fluorodeoxyglucose positron emission tomography-based textural features for prediction of event prone carotid atherosclerotic plaques. J. Nucl. Cardiol. 28, 1861–1871 (2021). https://doi.org/10.1007/s12350-019-01943-1

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  • DOI: https://doi.org/10.1007/s12350-019-01943-1

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