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J Am Coll Cardiol, 2006; 48:1818-1824, doi:10.1016/j.jacc.2006.05.076 (Published online 16 October 2006).
© 2006 by the American College of Cardiology Foundation
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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{dagger}, Gregory G. Bashian, MD*, Shahinaz Bedri, MBBS{ddagger}, David Vermylen, BA*, Ricardo C. Cury, MD{dagger}, Denise Yates, PhD{dagger}, Glenn M. LaMuraglia, MD||, Karen Furie, MD§, Stuart Houser, MD{ddagger}, Henry Gewirtz, MD*, James E. Muller, MD*, Thomas J. Brady, MD{dagger} and Alan J. Fischman, MD, PhD{dagger}

* Department of Medicine (Cardiac Unit), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
{dagger} Department of Radiology and Nuclear Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
{ddagger} 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


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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]



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