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CLINICAL RESEARCH: CARDIAC IMAGING

¹⁸Fluorodeoxyglucose Positron Emission Tomography Imaging of Atherosclerotic Plaque Inflammation Is Highly Reproducible

Implications for Atherosclerosis Therapy Trials

James H.F. Rudd, MD, PhD^_*,1,_*, Kelly S. Myers, BS^_*, Sameer Bansilal, MD, Josef Machac, MD, Ash Rafique, BS, Michael Farkouh, MD, MSc, Valentin Fuster, MD, PhD and Zahi A. Fayad, PhD, FACC, FAHA^_*

^_* Imaging Science Laboratories, Mount Sinai School of Medicine, New York, New York
Cardiovascular Imaging Clinical Trials Unit, Mount Sinai School of Medicine, New York, New York
Division of Nuclear Medicine, Department of Radiology, Mount Sinai School of Medicine, New York, New York
The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, New York.

Manuscript received February 19, 2007; revised manuscript received May 9, 2007, accepted May 14, 2007.

^_* Reprint requests and correspondence: Dr. James H. F. Rudd, ACCI Level 3, Addenbrookes Hospital, Cambridge CB2 2QQ, United Kingdom. (Email: jhfr2{at}cam.ac.uk).

Objectives: This study tested the near-term reproducibility of ¹⁸fluorodeoxyglucose positron emission tomography (FDG-PET) imaging of atherosclerosis.

Background: It is known that FDG-PET can measure inflammation within the aorta, carotid, and vertebral arteries with histologic validation in humans and animal models of disease. By tracking changes in inflammation over time, PET could be used as a surrogate marker of antiatheroma drug efficacy. However, the short-term variability and reproducibility of the technique are unknown.

Methods: We imaged the carotid arteries and aorta in 11 subjects with FDG-PET/computed tomography twice, 14 days apart. We assessed interobserver and intraobserver agreement and interscan variability.

Results: Interscan plaque FDG variability over 2 weeks was very low; intraclass correlation coefficients (ICC) ranged between 0.79 and 0.92. Interobserver agreement was high across all territories imaged except aortic arch (ICC values from 0.90 to 0.97, arch 0.71). Intraobserver agreement was high, with ICC values between 0.93 and 0.98.

Conclusions: Spontaneous change in plaque FDG uptake is low over 2 weeks, with favorable inter- and intraobserver agreement. Power calculations suggest that drug studies using FDG-PET imaging would require few subjects compared with other imaging modalities. This study strengthens the case for FDG-PET as a noninvasive plaque imaging technique.

Abbreviations and Acronyms   CT = computed tomography   FDG = 18fluorodeoxyglucose   ICC = intraclass correlation coefficient   MRI = magnetic resonance imaging   PET = positron emission tomography   ROI = region of interest   SUV = standardized uptake value   TBR = tissue-to-background ratio   2D = 2-dimensional   3D = 3-dimensional

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