Abstract T P175: Arterial and Venous Uptake of F-18 Fdg Could Predict Ischemic Stroke in Patients With Cancer

Abstract

Backgrounds: Arterial and venous thromboses readily occurs under hypercoagulable conditions and often occur together in patients with cancer. These thromboses is the main cause of ischemic stroke with cancer. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a reliable and well-established method for imaging of inflammation in thrombus and plaque. However, it is not known whether both arterial and venous FDG uptake detected on PET/CT imaging are associated with an enhanced risk of ischemic stroke in malignancy. We evaluated the association of vascular F-18 FDG uptake with the subsequent ischemic stroke in patients with cancer. Methods: Patients referred to FDG PET/CT for oncologic indications were compared between 27 patients occurred symptomatic ischemic stroke within a month after taking PET imaging and 81 controls, matched to age, gender, cancer type and staging. The maximal standardized uptake value (maxSUV) was divided by the blood-pool maxSUV, yielding a target-to-background ratio (TBR) for each vascular segment. The mean TBR was calculated in the common carotid artery (CCA), aorta, internal jugular vein (IJV), superior and inferior vena cavae (IVC). Results: The maxSUVs and TBRs of the CCA, abdominal aorta (AA), IJV and IVC were significantly higher in symptomatic ischemic stroke patients than in controls. In multiple logistic regression analysis, the maxSUVs and the TBRs of the CCA, AA, IJV and IVC were independent predictors for subsequent ischemic stroke after adjustment for covariates. The TBR of the CCA among the arterial PET parameters and the TBR of the IVC among the venous PET parameters had the highest odds ratio, and were the best for discriminating symptomatic ischemic stroke patients from controls and for predicting subsequent ischemic stroke. The optimal cut-off value of the TBRs of the CCA and IVC for predicting ischemic stroke were 1.08 and 1.04, respectively. Conclusion: This study suggests that increased arterial and venous uptake of F-18 FDG could be predict subsequent ischemic stroke in patients with cancer. Additional prospective studies with larger numbers of patients are needed to confirm the association of vascular FDG uptake with ischemic stroke.