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J Am Coll Cardiol, 2007; 50:892-896, doi:10.1016/j.jacc.2007.05.024 (Published online 10 August 2007).
© 2007 by the American College of Cardiology Foundation
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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{dagger}, Josef Machac, MD{ddagger}, Ash Rafique, BS{ddagger}, Michael Farkouh, MD, MSc{dagger}, Valentin Fuster, MD, PhD§ and Zahi A. Fayad, PhD, FACC, FAHA*

* Imaging Science Laboratories, Mount Sinai School of Medicine, New York, New York
{dagger} Cardiovascular Imaging Clinical Trials Unit, Mount Sinai School of Medicine, New York, New York
{ddagger} 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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