HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2006.05.076v1 48/9/1818    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (31) Citing Articles via Google Scholar Google Scholar Articles by Tawakol, A. Articles by Fischman, A. J. Search for Related Content PubMed PubMed Citation Articles by Tawakol, A. Articles by Fischman, A. J. Related Collections Related Article

CLINICAL RESEARCH: CARDIAC IMAGING

In Vivo ¹⁸ F-Fluorodeoxyglucose Positron Emission Tomography Imaging Provides a Noninvasive Measure of Carotid Plaque Inflammation in Patients

Ahmed Tawakol, MD^_*,_*, Raymond Q. Migrino, MD, Gregory G. Bashian, MD^_*, Shahinaz Bedri, MBBS, David Vermylen, BA^_*, Ricardo C. Cury, MD, Denise Yates, PhD, Glenn M. LaMuraglia, MD^||, Karen Furie, MD, Stuart Houser, MD, Henry Gewirtz, MD^_*, James E. Muller, MD^_*, Thomas J. Brady, MD and Alan J. Fischman, MD, PhD

^_* Department of Medicine (Cardiac Unit), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Department of Radiology and Nuclear Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
^|| Division of Vascular and Endovascular Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

Manuscript received July 27, 2005; revised manuscript received April 27, 2006, accepted May 2, 2006.

^_* Reprint requests and correspondence: Dr. Ahmed Tawakol, Cardiac Unit/YAW 5904, Massachusetts General Hospital, Boston, Massachusetts 02114. (Email: atawakol{at}partners.org).

OBJECTIVES: Given the importance of inflammation in atherosclerosis, we sought to determine if atherosclerotic plaque inflammation could be measured noninvasively in humans using positron emission tomography (PET).

BACKGROUND: Earlier PET studies using fluorodeoxyglucose (FDG) demonstrated increased FDG uptake in atherosclerotic plaques. Here we tested the ability of FDG-PET to measure carotid plaque inflammation in patients who subsequently underwent carotid endarterectomy (CEA).

METHODS: Seventeen patients with severe carotid stenoses underwent FDG-PET imaging 3 h after FDG administration (13 to 25 mCi), after which carotid plaque FDG uptake was determined as the ratio of plaque to blood activity (target to background ratio, TBR). Less than 1 month after imaging, subjects underwent CEA, after which carotid specimens were processed to identify macrophages (staining with anti-CD68 antibodies).

RESULTS: There was a significant correlation between the PET signal from the carotid plaques and the macrophage staining from the corresponding histologic sections (r = 0.70; p < 0.0001). When mean FDG uptake (mean TBR) was compared with mean inflammation (mean percentage CD68 staining) for each of the 17 patients, the correlation was even stronger (r = 0.85; p < 0.0001). Fluorodeoxyglucose uptake did not correlate with plaque area, plaque thickness, or area of smooth muscle cell staining.

CONCLUSIONS: We established that FDG-PET imaging can be used to assess the severity of inflammation in carotid plaques in patients. If subsequent natural history studies link increased FDG-PET activity in carotid arteries with clinical events, this noninvasive measure could be used to identify a subset of patients with carotid atherosclerosis in need of intensified medical therapy or carotid artery intervention to prevent stroke.

Abbreviations and Acronyms   CEA = carotid endarterectomy   FDG = 18 F-fluorodeoxyglucose   hsCRP = high-sensitivity C-reactive protein   PET = positron emission tomography   SUV = standardized uptake value   TBR = target-to-background ratio

Related Article

Simvastatin Attenuates Plaque Inflammation: Evaluation by Fluorodeoxyglucose Positron Emission Tomography

Nobuhiro Tahara, Hisashi Kai, Masatoshi Ishibashi, Hiroyuki Nakaura, Hayato Kaida, Kenkichi Baba, Naofumi Hayabuchi, and Tsutomu Imaizumi
J. Am. Coll. Cardiol. 2006 48: 1825-1831. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				S. J. Lee, Y. K. On, E. J. Lee, J. Y. Choi, B.-T. Kim, and K.-H. Lee Reversal of Vascular 18F-FDG Uptake with Plasma High-Density Lipoprotein Elevation by Atherogenic Risk Reduction J. Nucl. Med., August 1, 2008; 49(8): 1277 - 1282. [Abstract] [Full Text] [PDF]

				U. Flogel, Z. Ding, H. Hardung, S. Jander, G. Reichmann, C. Jacoby, R. Schubert, and J. Schrader In Vivo Monitoring of Inflammation After Cardiac and Cerebral Ischemia by Fluorine Magnetic Resonance Imaging Circulation, July 8, 2008; 118(2): 140 - 148. [Abstract] [Full Text] [PDF]

				R. M. Kwee, R. J. van Oostenbrugge, L. Hofstra, G. J. Teule, J.M.A. van Engelshoven, W. H. Mess, and M. E. Kooi Identifying vulnerable carotid plaques by noninvasive imaging Neurology, June 10, 2008; 70(24_Part_2): 2401 - 2409. [Abstract] [Full Text] [PDF]

				J. H.F. Rudd, K. S. Myers, S. Bansilal, J. Machac, C. A. Pinto, C. Tong, A. Rafique, R. Hargeaves, M. Farkouh, V. Fuster, et al. Atherosclerosis Inflammation Imaging with 18F-FDG PET: Carotid, Iliac, and Femoral Uptake Reproducibility, Quantification Methods, and Recommendations J. Nucl. Med., June 1, 2008; 49(6): 871 - 878. [Abstract] [Full Text] [PDF]

				M. Nahrendorf, H. Zhang, S. Hembrador, P. Panizzi, D. E. Sosnovik, E. Aikawa, P. Libby, F. K. Swirski, and R. Weissleder Nanoparticle PET-CT Imaging of Macrophages in Inflammatory Atherosclerosis Circulation, January 22, 2008; 117(3): 379 - 387. [Abstract] [Full Text] [PDF]

				D. Hartung, A. Petrov, N. Haider, S. Fujimoto, F. Blankenberg, A. Fujimoto, R. Virmani, F. D. Kolodgie, H. W. Strauss, and J. Narula Radiolabeled Monocyte Chemotactic Protein 1 for the Detection of Inflammation in Experimental Atherosclerosis J. Nucl. Med., November 1, 2007; 48(11): 1816 - 1821. [Abstract] [Full Text] [PDF]

				R. J. Gibbons, P. A. Araoz, and E. E. Williamson The Year in Cardiac Imaging J. Am. Coll. Cardiol., September 4, 2007; 50(10): 988 - 1003. [Full Text] [PDF]

				N. Tahara, H. Kai, H. Nakaura, M. Mizoguchi, M. Ishibashi, H. Kaida, K. Baba, N. Hayabuchi, and T. Imaizumi The prevalence of inflammation in carotid atherosclerosis: analysis with fluorodeoxyglucose positron emission tomography Eur. Heart J., September 2, 2007; 28(18): 2243 - 2248. [Abstract] [Full Text] [PDF]

				J. H.F. Rudd, K. S. Myers, S. Bansilal, J. Machac, A. Rafique, M. Farkouh, V. Fuster, and Z. A. Fayad 18Fluorodeoxyglucose Positron Emission Tomography Imaging of Atherosclerotic Plaque Inflammation Is Highly Reproducible: Implications for Atherosclerosis Therapy Trials J. Am. Coll. Cardiol., August 28, 2007; 50(9): 892 - 896. [Abstract] [Full Text] [PDF]

				F. A. Jaffer, P. Libby, and R. Weissleder Molecular Imaging of Cardiovascular Disease Circulation, August 28, 2007; 116(9): 1052 - 1061. [Full Text] [PDF]

				J. H.F. Rudd, J. Machac, and Z. A. Fayad Simvastatin and Plaque Inflammation J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1991 - 1991. [Full Text] [PDF]

				H. Kai, N. Tahara, M. Ishibashi, and T. Imaizumi Reply J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1991 - 1992. [Full Text] [PDF]