F-18 FDG PET-CT identifies patients at risk for future cardiovascular events in an otherwise asymptomatic cohort suffering from neoplastic disease

Objectives To evaluate the associations between arterial wall FDG uptake and calcifications in large arteries as detected by F-18-FDG PET-CT with the subsequent occurrence of cardio- and cerebrovascular events (CVE) in otherwise asymptomatic cancer patients.

Methods Clinical follow-up information of 1076 cancer patients examined with whole-body F-18-FDG PET-CT between 2004 and 2007 were obtained. In 16/1076 patients (1.5%), a CVE, defined as stroke, myocardial infarction or revascularization was registered. Of the remaining patients, 290 were randomly selected and their PET-CT results evaluated. Mean blood pool-corrected SUVs (TBR_mean) and a sum of calcified plaques (CP_sum) per patient were calculated from the major vessels: ascending, thoracic and abdominal aorta, aortic arch, iliac and carotid arteries.

Results A significant correlation was observed between CP_sum and TBR_mean (P<0.001). While CP_sum significantly correlated with all conventional CVE risk factors, TBR_mean correlated only with age, male gender and hypertension. The Cox regression hazard model identified TBR_mean ≥ 1.7 and CPsum ≥ 15 as independent predictors for the occurrence of CVE. Patients with both TBR_mean ≥ 1.7 and CP_sum ≥ 15 were identified as having highest risk for future CVE. However, TBR_mean ≥ 1.7 had greater prognostic value than did CP_sum ≥ 15.

Conclusions In a cohort of cancer patients a strong association was found between increased arterial wall FDG uptake and increased atherosclerotic plaque burden. Both F-18-FDG PET-CT vascular endpoints could identify high-risk patients in need of further cardiovascular diagnostics or intesified medical therapy.