Original article
Changing patterns of abnormal vascular wall F-18 fluorodeoxyglucose uptake on follow-up PET/CT studies

https://doi.org/10.1016/j.nuclcard.2006.07.008Get rights and content

Background

Fluorine 18 fluorodeoxyglucose (FDG) uptake may be increased in atherosclerotic plaques in asymptomatic patients. Repeat positron emission tomography (PET)/computed tomography (CT) studies were assessed for changes in patterns of FDG uptake and CT calcifications.

Methods and Results

Fifty consecutive cancer patients (mean age, 68 ± 8 years) had repeat PET/CT studies 8 to 26 months apart. PET, CT, and PET/CT images were retrospectively evaluated for vascular wall abnormalities and for interval changes in the thoracic and abdominal aortas, as well as in carotid and iliac arteries, classified as PET+/CT+, PET+/CT−, and PET−/CT+. There were 485 abnormal sites in the first study and 495 in the second. CT calcifications were found in 46 patients (92%) in the first study and in 47 (94%) in the second. Vascular wall FDG uptake was found in both studies in 37 patients (74%). The pattern changed in 57 of 119 PET+ sites (48%) in the second study compared with 15 of 366 PET− sites (4%) (P < .0001). In the second study new PET+ sites were observed in 36 of 111 sites (32%) versus new PET−/CT+ sites in 19 of 384 sites (5%) (P < .0001).

Conclusions

Changes in vascular FDG activity and CT calcifications can be assessed by repeat PET/CT. FDG-avid foci may represent a dynamic process, transient inflammation, whereas CT calcifications may indicate stable atherosclerosis. These preliminary results support the need for further research.

Section snippets

Patient Population

In the study we retrospectively enrolled 50 consecutive cancer patients, aged 50 years or older, in whom routine follow-up FDG-PET/CT imaging was performed for assessment of malignant tumors. Repeat studies were performed 8 to 26 months apart (median, 13 months). A detailed clinical history regarding the presence of cardiovascular risk factors such as diabetes, obesity, smoking, hypertension, hyperlipidemia, and history of cardiovascular disease or cardiovascular events (myocardial infarction,

Results

Increased focal vascular wall FDG uptake and vascular wall CT calcifications were found in 485 sites in 46 patients in the first study and in 495 sites in 47 patients in the follow-up study. There were 0 to 24 sites per patient (median, 10 sites).

Vascular CT calcifications were observed in the first study in 401 sites (83%) in 46 patients (92%) and were present in the second study in 422 sites (85%) in 47 patients (94%) (Table 2).

Increased focal vascular wall FDG uptake was observed in the

Discussion

Atherosclerosis is one of the leading causes of death in the world. More than 500,000 Americans die each year of coronary artery disease, and over 90% of sudden deaths occur in individuals with 2 or more narrowed arteries. Within an atherosclerotic plaque, a dynamic balance exists between the processes of erosion and rupture of the fibrous cap (mainly by the macrophages) and repair.1 A “vulnerable” plaque can precipitate a clinical event.23 Rupture, though independent of plaque size, is related

Acknowledgment

The authors have indicated they have no financial conflicts of interest.

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    This study was supported in part by the Eliyahu Pen Technion Research Grant.

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