Methods of PET/CT image analysis for quantification of atherosclerosis in major vessels

Learning Objectives To review current image analysis methods for quantification of atherosclerotic plaques in vascular wall by using FDG PET/CT.

Atherosclerosis plays a major role in cardiovascular events. FDG PET/CT imaging has been shown to be an accurate and reliable method in detecting and quantifying the process of cellular inflammation in atherosclerotic plaque. Several image analysis approaches and PET/CT or PET/MRI derived image biomarkers have been used for measurement of inflammation and calcification in the major vessels including aorta and carotids and peripheral vessels. In this review, we will compare characteristics of these methods and biomarkers: 1. Methods of measurement: i. Qualitative; ii. Semi-quantitative: a. SUVmax, b. SUVmean, c. Target to background ratio (TBR), d. Target to background difference (TBD), c. Blood pool uptake selection methods, d. Effect of coverage extent and slice skipping, e. Index vessel selection, f. Most-diseased vs. most-active segment selection, g. Plaque based analysis; iii. Quantitative: a. Partial volume effect estimation and correction in the vascular wall, b. Global inflammatory burden, c. Time consumption vs. precision