Abstract

BackgroundDetection of vulnerable plaques could be clinically significant in the prevention of cardiovascular events. We aimed to compare Fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in vulnerable and stable plaques, and investigate the feasibility of predicting thrombosis events using Positron Emission Tomography/Computed Tomography (PET/CT) angiography.MethodsAtherosclerosis was induced in 23 male New Zealand white rabbits. The rabbits underwent pharmacological triggering to induce thrombosis. A pre-triggered PET/CTA scan and a post-triggered PET/CTA scan were respectively performed. 18F-FDG uptake by the aorta was expressed as maximal standardized uptake value (SUVmax) and mean SUV (SUVmean). SUVs were measured on serial 7.5 mm arterial segments.ResultsThrombosis was identified in 15 of 23 rabbits. The pre-triggered SUVmean and SUVmax were 0.768±0.111 and 0.804±0.120, respectively, in the arterial segments with stable plaque, and 1.097±0.189 and 1.229±0.290, respectively, in the arterial segments with vulnerable plaque (P<0.001, respectively). The post-triggered SUVmean and SUVmax were 0.849±0.167 and 0.906±0.191, respectively in the arterial segments without thrombosis, and 1.152±0.258 and 1.294±0.313, respectively in the arterial segments with thrombosis (P<0.001, respectively). The values of SUVmean in the pre-triggered arterial segments were used to plot a receiver operating characteristic curve (ROC) for predicting thrombosis events. Area under the curve (AUC) was 0.898. Maximal sensitivity and specificity (75.4% and 88.5%, respectively) were obtained when SUVmean was 0.882.ConclusionsVulnerable and stable plaques can be distinguished by quantitative analysis of 18F-FDG uptake in the arterial segments in this rabbit model. PET/CT may be used for predicting thrombosis events and risk-stratification in patients with atherosclerotic disease.

Highlights

  • Atherosclerosis is a progressive and inflammatory disease characterized by the accumulation of lipids and fibrous elements in the arteries

  • The rabbits were first fed with high cholesterol diet for atherosclerosis model and thrombosis was induced in these rabbits by injection of Russell’s viper venom (RVV)

  • The lumen stenosis and vessel wall irregularities are obvious on CT angiographic imaging (A1) and evident 18F-FDG uptake was observed on Positron Emission Tomography/Computed Tomography (PET/CT) images (A2)

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Summary

Introduction

Atherosclerosis is a progressive and inflammatory disease characterized by the accumulation of lipids and fibrous elements in the arteries. The early detection of these prone to-rupture plaques (vulnerable plaques) is clinically relevant to risk stratification and prevention of severe and acute atherosclerotic complications. High-resolution intravascular imaging modalities, including virtual histology intravascular ultrasound, optical coherence tomography, and intravascular magnetic resonance imaging (IV-MRI), permit direct imaging of the plaques and vessel wall [3]. These invasive imaging methods require considerable time, expertise, and expense, and none is suitable for screening atherosclerosis and vulnerable plaques in asymptomatic patients. Detection of vulnerable plaques could be clinically significant in the prevention of cardiovascular events. We aimed to compare Fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in vulnerable and stable plaques, and investigate the feasibility of predicting thrombosis events using Positron Emission Tomography/Computed Tomography (PET/CT) angiography

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