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Figure 4 Single-photon emission computed tomography (SPECT) images of unstable atherosclerotic carotid artery lesions obtained with Tc99m-annexin-A5. (A) shows transverse and coronal views obtained by SPECT in Patient #1, who had a left-sided transient ischemic attack (TIA) 3 days before imaging. Patient #1 had significant stenoses of both carotid arteries; however, the uptake of Tc99m-annexin-A5 is evident only in the culprit lesion (arrows). Histopathology of an endarterectomy specimen from Patient #1 (B, anti–annexin-A5 antibody) shows substantial infiltration of macrophages into the neointima, with extensive binding of annexin-A5 (brown staining). In contrast, SPECT images of Patient #2 (C), who had had a right-sided TIA three months before imaging, do not show annexin-A5 uptake in the carotid region on both sides. Doppler ultrasonography revealed a clinically significant obstructive lesion on the affected side. Histopathological analysis of an endarterectomy specimen from Patient #2 (D) shows a lesion rich in smooth-muscle cells, with negligible binding of annexin-A5. ANT = anterior; L = left. Reprinted, with permission, from Kietselaer et al. (25).
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