Role of PET/CT in vascular dementia

Objectives: • Review the current standard imaging techniques and guidelines for atherosclerosis and dementia • Discuss the role of PET/CT/MRI in assessing cognitive impairment and dementia, with emphasis on vascular disorders • Highlight the importance of ¹⁸F Sodium Fluoride (NaF)-PET and FDG-PET in early-stage detection of carotid artery atherosclerosis and its impact on cognitive function • Determine the correlation between atherosclerosis (as measured by NaF uptake) and brain function (FDG uptake), including cognitive impairment and multi-infarct dementias Methods: Vascular dementia is a progressive cerebrovascular disorder caused by reduced blood flow to the brain and possible emboli, which may lead to significant loss of brain function. This condition may be preceded for years by the buildup of atherosclerotic plaques in the carotid arteries. Among the dementias, cerebrovascular disorders potentially can be stabilized or treated effectively to improve brain functions. Therefore, we believe this approach will have a substantial impact in treating the aging population suffering from cognitive impairment. Additionally, patients with Alzheimer’s Disease who suffer from carotid artery disease may also benefit from undergoing such imaging techniques.

Results: This educational exhibit will describe the existing, novel imaging techniques that are currently employed to assess atherosclerosis and vascular dementia in great detail. In particular, we will review the current state of the art in regard to the use of NaF-PET and FDG-PET in assessing atherosclerosis and whole-brain function. In recent years, it has been shown that NaF-PET is a very sensitive and specific methodology for identifying the molecular calcification in atherosclerosis within various arteries, including the aorta and the carotids. Similarly, FDG-PET has been used over the past decade to detect inflammation in the plaques with some success. We will discuss the role of FDG-PET in detecting brain function regionally as well as globally to assess the consequences of atherosclerotic disease on cognition and mental performance of the affected population. However, it is increasingly apparent that FDG-PET may not be as sensitive or specific as NaF-PET in early diagnosis of atherosclerosis. Therefore, we believe NaF-PET may prove to be the tool of choice for detecting early-stages of atherosclerosis when therapeutic interventions may prove to be effective in reversing the process (Figure 1). As such, we project a major role for PET imaging in assessing patients with various underlying causes of cognitive impairment and dementia by performing these powerful imaging techniques.

Conclusions: NaF-PET and FDG-PET are infrequently performed to determine molecular calcification in the carotids and brain function, respectively. The main aim of this education exhibit is to make the molecular imaging community aware of the great potential of these approaches in addressing a major healthcare issue affecting the aging population worldwide. We believe that future prospective studies should be designed to validate the role of this powerful imaging technique in the diagnosis and management of patients with cognitive impairment and dementia.

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