Article Figures & Data
Figures
- FIGURE 1.
PET/CT image analysis. (A) Example of modified calcified plaque scoring system (16). Images from left to right show scores of 0 (no calcified plaque), 1 (calcified plaque involving <10% of vessel circumference), 2 (calcified plaque involving 10%−25%), 3 (calcified plaque involving 25%−50%), and 4 (calcified plaque involving >50%). (B) Example of TBR calculation method. ROIs were drawn in center of vena cava inferior (red) and in arterial wall of abdominal aorta (black). ABA = abdominal aorta; CP = calcified plaque.
- FIGURE 2.
Arterial 18F-FDG uptake and calcifications in relation to patient outcome. From left to right are representative transaxial CT, 18F-FDG PET, and fused PET/CT images. (A) 81-y-old man with significantly increased uptake in region of aortic arch (TBR, 1.78; mean TBR, 1.62). Calcified plaque in aortic arch was 3, and calcified plaque sum was 21. Patient experienced myocardial infarction 14 mo later. (B) 45-y-old man with calcified plaque score of 0 in aortic arch (calcified plaque sum, 2) but aortic arch TBR of 1.90 (mean TBR, 1.74), who experienced vascular event 14 mo after PET/CT. (C) 64-y-old woman with calcified plaque score of 4 in abdominal aorta (calcified plaque sum, 14) and TBR of 1.49 in abdominal aorta (mean TBR, 1.56), who experienced no vascular event during follow-up.
- FIGURE 3.
Kaplan–Meier cumulative event-free survival curves: mean TBR using mean TBR cutoff of ≥1.7 (A), calcified plaque sum using calcified plaque sum cutoff of ≥15 (B), and combined subgroups of mean TBR and calcified plaque sum (C). *P < 0.01. **P < 0.001.
- FIGURE 4.
Distribution of arterial segments with different patterns of 18F-FDG uptake and calcifications in patients with and without vascular event during follow-up: proportional and disproportional distribution patterns in event group vs. control group (A); arterial segments with high TBR and low calcified plaque values vs. segments with low TBR and high calcified plaque values (B).
Tables
Parameter Control group (n = 319) Event group (n = 15) P Median age (y) 59.0 (48.0, 66.0) 66.0 (55.0, 71.5) <0.05 Men (n) 123 (38.6%) 10 (66.7%) <0.05 Body mass index 25.2 ± 4.6 (15.0, 48.0) 25.8 ± 5.6 (17.0, 35.0) NS Median follow-up time (mo) 30.0 (20.0, 36.0) 27.0 (21.0, 33.0) NS Events (n) 15 Cardiac 10 Cerebral 5 Cardiovascular risk factors (n) Hypercholesterolemia 57 (17.9%) 3 (20%) NS Hypertension 60 (18.8%) 11 (73.3%) <0.05 Smoker 30 (9.4%) 4 (26.7%) NS Diabetes mellitus 15 (4.7%) 1 (6.7%) NS Family history of cardiovascular disease 76 (25.2%) 5 (33.3%) NS Mean calcified plaque sum 4.6 ± 5.6 (0, 30) 10.9 ± 8.3 (0, 23) <0.05 Mean TBR 1.3 ± 0.2 (0.8, 2.0) 1.9 ± 0.6 (1.4, 3.9) <0.05 Therapy (n) Current statin medication 14 (4.4%) 1 (6.7%) NS Ongoing chemotherapy 43 (13.5%) 2 (13.3%) NS NS = not statistically significant.
Values are mean ± SD followed by range, median followed by (Q1, Q3), or number followed by percentage.
Future cerebrovascular or cardiovascular event Univariate analysis Multivariate analysis Parameter HR 95% CI P HR 95% CI P Age (≥65 y) 2.181 0.790–6.023 0.132 NS Sex (M) 3.355 1.144–9.804 0.027 NS Cardiovascular risk factor (+)* 12.130 1.595–92.238 0.016 8.711 1.126–67.386 0.038 Calcified plaque sum (≥15) 9.200 3.232–26.192 <0.0001 3.560 1.171–10.821 0.025 Mean TBR (≥1.7) 20.291 7.214–57.071 <0.0001 14.144 4.823–41.482 <0.0001 ↵* Minimum of 1 cardiovascular risk factor present, such as family history, hypercholesterolemia, diabetes, hypertension, or smoking.
HR = hazard ratio; CI = confidence interval; NS = not statistically significant.
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