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Clinical Investigations |
1 Department of Nuclear Medicine, Carmel Medical Center, Haifa, Israel
2 The B. Rapaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
3 Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel
4 Department of Epidemiology and Biostatistics, Carmel Medical Center, Haifa, Israel
Glucose metabolic activity expressed as 18F-FDG uptake may be increased in active atherosclerotic plaque. Calcium depositions are often increased in mature atherosclerotic plaque. The purpose of the present study was to assess the patterns of vascular-wall 18F-FDG uptake and CT calcifications using combined PET/CT. Methods: One hundred twenty-two consecutive patients over the age of 50 (47 women and 75 men; mean age, 66 ± 9 y) undergoing whole-body 18F-FDG PET/CT for tumor assessment were retrospectively evaluated. PET, CT, and PET/CT slices were generated for review. Abnormal vascular findings in major arteries in the chest and abdomen were categorized as PET positive (PET+), PET negative (PET–), CT positive (CT+), or CT negative (CT–). The topographic relationship between increased vascular-wall 18F-FDG uptake on PET and the presence of calcifications on CT was assessed on PET/CT fused images, with abnormal sites further classified as PET+/CT+, PET+/CT–, or PET–/CT+. The presence of CT calcifications and increased vascular-wall 18F-FDG uptake was correlated with age, sex, presence of cardiovascular risk factors, and cardiovascular disease. Results: Abnormal findings were identified at 349 sites. CT calcifications (CT+) were observed at 320 sites (92%) of 100 patients (82%), more commonly in men (P < 0.03), in older patients (P < 0.0001), in patients with hypertension (P < 0.003) or hyperlipidemia (P < 0.04), and in smokers (P < 0.008). Increased vascular-wall 18F-FDG uptake (PET+) was observed at 52 sites (15%) of 38 patients (31%), more commonly in men (P < 0.02), in older patients (P < 0.0001), and in patients with hypertension (P < 0.02), and was borderline in patients with cardiovascular disease (P = 0.057). PET+ and CT+ findings correlated in 12 patients, a PET+/CT– pattern was found in 18 patients, and 8 patients had increased vascular-wall 18F-FDG uptake in sites with and without calcifications (PET+/CT+, CT–). Twenty-two patients (18%) had a PET–/CT– pattern. Conclusion: Hybrid PET/CT can be used to identify and to correctly localize vascular-wall 18F-FDG activity. Increased vascular-wall 18F-FDG activity was found in 15% of sites and CT calcifications were noted in 92% of sites, with congruent findings in 7%. The clinical significance of the relationship between vascular-wall 18F-FDG uptake and CT calcifications needs to be assessed by further prospective studies with long-term follow up.
Key Words: hybrid imaging • PET/CT • atherosclerosis • arterial calcifications
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