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Evaluation of non-stenotic carotid atherosclerotic plaques with combined FDG-PET imaging and CT angiography in patients with ischemic stroke of unknown origin

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Objectives

Non-stenotic plaques are an underestimated cause of ischemic stroke. Imaging aspects of high-risk carotid plaques can be identified on CT angiography (CTA) and 18F-fluoro-deoxyglucose positron emission tomography (FDG-PET) imaging. We evaluated in patients with cryptogenic ischemic stroke the usefulness of FDG-PET-CTA.

Methods

44 patients imaged with CTA and FDG-PET were identified retrospectively. Morphological features were identified on CTA. Intensity of FDG uptake in carotid arteries was quantified on PET.

Results

Patients were imaged 7 ± 8 days after stroke. 44 non-stenotic plaques with increased 18F-FDG uptake were identified in the carotid artery ipsilateral to stroke and 7 contralateral. Most-diseased-segment TBR on FDG-PET was higher in artery ipsilateral vs. contralateral to stroke (2.24 ± 0.80 vs. 1.84 ± 0.50; p < .05). In the carotid region with high FDG uptake, prevalence of hypodense plaques and extent of hypodensity on CTA were higher in artery ipsilateral vs. contralateral to stroke (41% vs. 11%; 0.72 ± 1.2 mm2 vs. 0.13 ± 0.43 mm2; p < .05).

Conclusions

In patients with ischemic stroke of unknown origin and non-stenotic plaques, we found an increased prevalence of high-risk plaques features ipsilateral vs. contralateral to stroke on FDG-PET-CTA imaging suggesting a causal role for these plaques.

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Abbreviations

CTA:

Computed tomographic angiography

FDG:

Fluorodeoxyglucose

MDS:

Most-diseased segment

PET:

Positron emission tomography

TBR:

Tissue to background ratio

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Author notes

  1. Pierre Amarenco and Fabien Hyafil Contributed equally / Shared.

Authors and Affiliations

  1. Department of Nuclear Medicine, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France

    Nidaa Mikail MD

  2. Department of Neurology, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France

    Elena Meseguer MD, Philippa Lavallée MD, Isabelle Klein MD, Cristina Hobeanu MD, Céline Guidoux MD, Lucie Cabrejo MD & Pierre Amarenco MD, PhD

  3. Department of Vascular Surgery, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France

    Guy Lesèche MD, PhD

  4. Department of Nuclear Medicine, Georges-Pompidou European Hospital, DMU IMAGINA, Assistance Publique-Hôpitaux de Paris, University of Paris, 20 rue Leblanc, 75015, Paris, France

    Fabien Hyafil MD, PhD

Authors
  1. Nidaa Mikail MD
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  2. Elena Meseguer MD
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Correspondence to Fabien Hyafil MD, PhD.

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Mikail, N., Meseguer, E., Lavallée, P. et al. Evaluation of non-stenotic carotid atherosclerotic plaques with combined FDG-PET imaging and CT angiography in patients with ischemic stroke of unknown origin. J. Nucl. Cardiol. 29, 1329–1336 (2022). https://doi.org/10.1007/s12350-020-02511-8

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  • DOI: https://doi.org/10.1007/s12350-020-02511-8

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