Carotid Plaque Inflammation Imaged by PET and Prediction of Recurrent Stroke at 5 Years

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012909
Author(s):  
John Joseph McCabe ◽  
Pol Camps-Renom ◽  
Nicola Giannotti ◽  
Jonathan P. McNulty ◽  
Sarah Coveney ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Pet Imaging ◽  
Carotid Plaque ◽  
Recurrent Stroke ◽  
Carotid Revascularization ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Stenosis Severity ◽  
Plaque Inflammation

Objective:To determine whether carotid plaque inflammation identified by 18F-fluorodeoxyglucose (18FDG)-PET is associated with late (5-year) recurrent stroke.Methods:We did an individual-participant data pooled analysis of three prospective studies with near-identical study methods. Eligible patients had recent non-severe (modified Rankin Score ≤3) ischaemic stroke/TIA and ipsilateral carotid stenosis (50-99%). Participants underwent carotid 18FDG-PET/CT angiography ≤14 days after recruitment. 18FDG uptake was expressed as maximum standardized uptake value (SUVmax) in the axial single hottest slice of symptomatic plaque. We calculated the previously-validated Symptomatic Carotid Atheroma Inflammation Lumen-stenosis (SCAIL) score, which incorporates a measure of stenosis severity and 18FDG uptake. The primary outcome was 5-year recurrent ipsilateral ischaemic stroke after PET imaging.Results:Of 183 eligible patients, 181 patients completed follow-up (98.9%). The median duration of follow-up was 4.9 years (interquartile range 3.3-6.4, cumulative follow-up period 901.8 patient-years). After PET imaging, 17 patients had a recurrent ipsilateral ischemic strokes at 5 years (recurrence rate 9.4%, 95% CI 5.6-14.6%). Baseline plaque SUVmax independently predicted 5-year ipsilateral recurrent stroke after adjustment for age, gender, carotid revascularization, stenosis severity, NIH Stroke Scale, and diabetes mellitus (adjusted HR 1.98; 95 % CI, 1.10-3.56, p=0.02, per 1g/mL increase SUVmax). On multivariable Cox regression, SCAIL score predicted 5-year ipsilateral stroke (adjusted HR 2.73 per 1-point increase; 95% CI 1.52-4.90, p=0.001).Conclusion:Plaque inflammation-related 18FDG uptake improved identification of 5-year recurrent ipsilateral ischaemic stroke. Addition of plaque inflammation to current selection strategies may target patients most likely to have late as well as early benefit from carotid revascularization.Classification of Evidence:This study provides Class I evidence that in individuals with recent ischemic stroke/TIA and ipsilateral carotid stenosis, carotid plaque inflammation-related 18FDG uptake on PET/CT angiography was associated with 5-year recurrent ipsilateral stroke.

scholarly journals Cohort profile: BIOVASC-late, a prospective multicentred study of imaging and blood biomarkers of carotid plaque inflammation and risk of late vascular recurrence after non-severe stroke in Ireland

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038607
Author(s):  
John Joseph McCabe ◽  
Nicola Giannotti ◽  
Jonathan McNulty ◽  
Sean Collins ◽  
Sarah Coveney ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Inflammatory Cytokines ◽  
Fdg Pet ◽  
Carotid Plaque ◽  
Recurrent Stroke ◽  
Vascular Events ◽  
Severe Stroke ◽  
Symptomatic Carotid ◽  
Fdg Uptake ◽  
Plaque Inflammation

PurposeInflammation is important in stroke. Anti-inflammatory therapy reduces vascular events in coronary patients. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) identifies plaque inflammation-related metabolism. However, long-term prospective cohort studies investigating the association between carotid plaque inflammation, identified on 18F-FDG PET and the risk of recurrent vascular events, have not yet been undertaken in patients with stroke.ParticipantsThe Biomarkers Imaging Vulnerable Atherosclerosis in Symptomatic Carotid disease (BIOVASC) study and Dublin Carotid Atherosclerosis Study (DUCASS) are two prospective multicentred observational cohort studies, employing near-identical methodologies, which recruited 285 patients between 2008 and 2016 with non-severe stroke/transient ischaemic attack and ipsilateral carotid stenosis (50%–99%). Patients underwent coregistered carotid 18F-FDG PET/CT angiography and phlebotomy for measurement of inflammatory cytokines. Plaque 18F-FDG-uptake is expressed as maximum standardised uptake value (SUVmax) and tissue-to-background ratio. The BIOVASC-Late study is a follow-up study (median 7 years) of patients recruited to the DUCASS/BIOVASC cohorts.Findings to dateWe have reported that 18F-FDG-uptake in atherosclerotic plaques of patients with symptomatic carotid stenosis predicts early recurrent stroke, independent of luminal narrowing. The incorporation of 18F-FDG plaque uptake into a clinical prediction model also improves discrimination of early recurrent stroke, when compared with risk stratification by luminal stenosis alone. However, the relationship between 18F-FDG-uptake and late vascular events has not been investigated to date.Future plansThe primary aim of BIOVASC-Late is to investigate the association between SUVmax in symptomatic ‘culprit’ carotid plaque (as a marker of systemic inflammatory atherosclerosis) and the composite outcome of any late major vascular event (recurrent ischaemic stroke, coronary event or vascular death). Secondary aims are to investigate associations between: (1) SUVmax in symptomatic plaque, and individual vascular endpoints (2) SUVmax in asymptomatic contralateral carotid plaque and SUVmax in ipsilateral symptomatic plaque (3) SUVmax in asymptomatic carotid plaque and major vascular events (4) inflammatory cytokines and vascular events.

Carotid Plaque Inflammation Assessed by 18F-FDG PET/CT and Lp-PLA2 Is Higher in Symptomatic Patients

Angiology ◽  
2020 ◽  
pp. 000331972096541
Author(s):  
Alicia Bueno ◽  
Jose Ramon March ◽  
Pilar Garcia ◽  
Cristina Cañibano ◽  
Antonio Ferruelo ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Carotid Plaques ◽  
Fdg Uptake ◽  
Standardized Uptake Values ◽  
Asymptomatic Patients ◽  
Pet Ct ◽  
Significant Difference ◽  
Plaque Inflammation ◽  
Artery Disease

Carotid plaque inflammation assessed by 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels are higher in symptomatic patients. The aim of this study was to assess correlations between 18F-FDG uptake on PET scan of carotid artery plaques, plasma levels of Lp-PLA2, and cerebrovascular symptoms. The study included 45 consecutive patients (22 symptomatic, 23 asymptomatic) with >70% carotid stenosis. Patients were examined by hybrid PET/CT, and maximum standardized uptake values (SUVmax) were recorded. Blood samples were obtained, and plasma was stored at −80 °C for subsequent Lp-PLA2 analysis. Symptomatic and asymptomatic patients showed no significant difference in classical cardiovascular risk factors. Asymptomatic carotid stenosis patients more frequently had a history of coronary artery disease ( P = .025) and peripheral artery disease ( P = .012). The symptomatic group had higher 18F-FDG uptake in carotid plaques ( P < .001), higher plasma Lp-PLA2 ( P < .01), and higher high-sensitive C-reactive protein ( P = .022). 2-Deoxy-2-[18F]fluoro-D-glucose uptake on PET/CT and plasma Lp-PLA2 show a statistically significant association with the symptomatic status of carotid plaques.

scholarly journals A Risk Score Including Carotid Plaque Inflammation and Stenosis Severity Improves Identification of Recurrent Stroke

Stroke ◽  
2020 ◽  
Vol 51 (3) ◽  
pp. 838-845 ◽  
Author(s):  
Peter J. Kelly ◽  
Pol Camps-Renom ◽  
Nicola Giannotti ◽  
Joan Martí-Fàbregas ◽  
Jonathan P. McNulty ◽  
...  
Keyword(s):  
Risk Score ◽  
Carotid Plaque ◽  
Recurrent Stroke ◽  
Stenosis Severity ◽  
Plaque Inflammation

scholarly journals Quantitative analysis of myocardial metabolic heterogeneity is superior to visual assessment for the detection of active cardiac sarcoidosis by F-18 FDG PET-CT imaging

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Malik ◽  
M Yazdani ◽  
SM Gould ◽  
E Reyes
Keyword(s):  
Fdg Pet ◽  
Cardiac Sarcoidosis ◽  
Visual Assessment ◽  
Ct Imaging ◽  
Myocardial Inflammation ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Metabolic Heterogeneity ◽  
Fdg Pet Ct

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial inflammation may occur in the context of a multisystem disease such as sarcoidosis, adversely affecting prognosis. A definitive diagnosis of cardiac sarcoidosis (CS) is essential to implementing life-saving treatment but this is complicated by the invasive nature of endomyocardial biopsy (EMB) and its low accuracy. Positron emission tomography (PET) assists in diagnosis, which relies on visual interpretation of myocardial F-18 FDG uptake. The value of quantitative analysis and its application to clinical practice remain uncertain. Purpose To investigate the power of quantitative F-18 FDG PET-CT imaging analysis for detecting CS in patients with suspected disease. Methods All patients underwent F-18 FDG PET-CT after a 24-hour low-carbohydrate diet and 15-hour fasting as part of their diagnostic work-up for suspected cardiac inflammation. Cardiovascular magnetic resonance acted as gatekeeper to PET-CT in 8 of every 10 scans. Myocardial F-18 FDG uptake was assessed qualitatively and quantitatively using both manually drawn regions of interest and automatic polar maps to measure global and segmental standardised F-18 FDG uptake values (SUV).  The coefficient of variation (CoV) was calculated to determine uptake heterogeneity. To confirm diagnosis, follow-up data regarding disease progression, further testing and treatment were collected. To allow for sufficient follow-up time, the first 40 consecutive patients from a prospective registry (n= 214; Sep 2017-Jun 2020) were included. Results A comprehensive clinical picture was obtained successfully in 37 patients (median [IQR], 17 [13.5] months) and a final diagnosis of CS reached in 7 (disease prevalence, 19%). EMB was performed in 2 patients only while 3 underwent PPM/ICD implantation. Significant predictors of CS were fulfilment of Japanese Ministry of Health and Welfare criteria (Wald, 6.44; p = 0.01) and left ventricular dysfunction (Wald 6.72; p = 0.01). Qualitative F-18 FDG PET-CT had a high negative (95%) but low positive (45%) predictive value for CS (sensitivity, 83%; specificity, 77%). F-18 FDG SUV CoV was the strongest imaging predictor (Wald, 6.77; p = 0.009) and was significantly higher in CS than non-CS (CoV median [quartiles], 0.26 [0.21, 0.36] and 0.12 [0.11, 0.14] respectively; p = 0.004). As per ROC curve analysis (AUC, 0.84), a CoV threshold of 0.20 was highly specific (93%) and sensitive (86%) for CS. Conclusion In a referring population with a low prevalence of cardiac sarcoidosis, F-18 FDG PET-CT imaging is sensitive for the detection of myocardial inflammation with active disease unlikely in patients with a negative scan. Quantitative evaluation of metabolic heterogeneity within the myocardium provides a strong, independent marker of active disease and should be considered alongside visual assessment.

scholarly journals Quantitative, Dynamic 18F-FDG PET/CT in Monitoring of Smoldering Myeloma: A Case Report

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 649
Author(s):  
Christos Sachpekidis ◽  
Matthias Türk ◽  
Antonia Dimitrakopoulou-Strauss
Keyword(s):  
Bone Marrow ◽  
Plasma Cells ◽  
Autologous Transplantation ◽  
Standardized Uptake Value ◽  
Focal Lesions ◽  
Fdg Uptake ◽  
Pet Ct ◽  
18F Fdg ◽  
Smoldering Myeloma

We report on a 52-year-old patient with an initial diagnosis of smoldering myeloma (SMM), who was monitored by means of dynamic and static positron emission tomography/computed tomography (PET/CT) with the radiotracer 1⁸F-fluorodeoxyglucose (18F-FDG). Baseline PET/CT revealed no pathological signs. Six months later, a transition to symptomatic, multiple myeloma (MM) was diagnosed. The transition was not accompanied by focal, hypermetabolic lesions on PET/CT. However, a diffusely increased 18F-FDG uptake in the bone marrow, accompanied by a marked increase of semi-quantitative (standardized uptake value, SUV) and quantitative, pharmacokinetic 18F-FDG parameters, was demonstrated. After successful treatment, including tandem autologous transplantation, the diffuse uptake in the bone marrow as well as the semi-quantitative and quantitative parameters showed a marked remission. This response was also confirmed by the clinical follow-up of the patient. These findings suggest that in MM a diffuse 18F-FDG uptake in the bone marrow may indeed reflect an actual bone marrow infiltration by plasma cells. Moreover, SUV values and kinetic parameters, not only from myeloma lesions but also from random bone marrow samples, may be used for MM monitoring. This could be particularly helpful in the follow-up of myeloma patients negative for 18F-FDG-avid focal lesions.

When to image carotid plaque inflammation with FDG PET/CT

2010 ◽  
Vol 31 (9) ◽  
pp. 773-779 ◽  
Author(s):  
Martin Graebe ◽  
Lise Borgwardt ◽  
Liselotte Højgaard ◽  
Henrik Sillesen ◽  
Andreas Kjaer
Keyword(s):  
Fdg Pet ◽  
Carotid Plaque ◽  
Pet Ct ◽  
Plaque Inflammation ◽  
Fdg Pet Ct

scholarly journals High Grade tumor vs stroke. Utility of PET and MRI corregistration

ANALES RANM ◽  
2021 ◽  
Vol 138 (138(02)) ◽  
pp. 176-179
Author(s):  
M.N. Cabrera-Martín ◽  
P. Romero Fernández ◽  
M.K. Meneses Navas ◽  
P. Pérez-Segura ◽  
M. Yus Fuertes ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
High Grade Glioma ◽  
Whole Body ◽  
High Grade ◽  
Mr Images ◽  
Fdg Uptake ◽  
Area Of Interest ◽  
Pet Ct ◽  
Adjacent Brain

Sometimes, the clinical presentation of a brain tumour mimics that of stroke or viceversa. In these cases it is useful to evaluate follow-up with MR. The coregistration of PET and MR images improves the diagnostic performance of both techniques. In the area of interest, FDG uptake of any degree, with reference to the adjacent brain tissue uptake, should be considered suggestive of tumor if it corresponds to brain injury in MR, even when the FDG uptake is equal to or lower than that of the normal cerebral cortex. We present a case in which coregistration of images from both techniques contributed to the differential diagnosis of stroke and high-grade glioma, whole-body PET/CT ruled out metastatic etiology, and the results led to surgery.

Abstract 12920: The Value of 18 FDG PET/CT in the Diagnostic Work-Up of Patients With Possible Infective Endocarditis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fabio Chirillo ◽  
Franco Boccaletto ◽  
Paola Pantano ◽  
Alessandro De Leo ◽  
Marta Possamai ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Clinical Judgment ◽  
Predictive Value ◽  
Fdg Pet ◽  
Blood Cultures ◽  
Fdg Uptake ◽  
Duke Criteria ◽  
Pet Ct ◽  
Fdg Pet Ct

The diagnosis of infective endocarditis (IE) is sometimes difficult when there are discrepancies between blood cultures, transesophageal echocardiography (TEE) and clinical judgment. The aim of this study was to assess the incremental diagnostic value of 18 F-FDG-PET/CT in 45 consecutive patients (73% male, mean age 61 ± 26 years) with suspected IE and inconclusive tests at admission. In 28 patients (19 with a cardiac valvular (15) or nonvalvular (4) device) with blood cultures positive for germs typically involved in IE the initial TEE was negative or inconclusive. In 10 patients presenting with fever TEE identified cardiac lesion possibly related to IE (ruptured mitral chordae, thickened valve leaflet, thickened prosthetic annulus), but blood cultures were persistently negative. Finally, 7 patients had metastatic or embolic lesions and a predisposing cardiac condition, but TEE was negative. When previous unknown lesions detected by PET/CT were confirmed by succeeding examinations, they were considered true positives. When PET/CT was negative, it was compared with the final diagnosis that was defined according to the modified Duke criteria determined during a 6-month follow-up. Thirty patients had definite IE at the end of the follow-up, 3 had possible IE, and in 12 patients the diagnosis was rejected. Twenty-seven patients (60%) exhibited abnormal FDG uptake around the cardiac valves, and 12 (27%) had extracardiac accumulation. In 5 patients the initial negative TEE became positive a mean 5 ±7 days after PET/CT had been performed The sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT were as follows (95% confidence interval): 87% (68% to 95%), 67% (38% to 87%), 84% (65% to 94%), and 71% (42% to 92%), respectively. Adding abnormal FDG uptake as a new major criterion significantly increased the sensitivity of the modified Duke criteria at admission (68% [53% to 82%] vs. 96% [88% to 99%], p = 0.01). This result was due to a significant reduction (p < 0.001) in the number of possible IE cases. In conclusion PET/CT increases the diagnostic accuracy for IE in the subset of patients with possible IE and may help to manage a challenging situation.

scholarly journals Diffusely Increased 18F-FDG Uptake in the Thyroid Gland and Risk of Thyroid Dysfunction: A Cohort Study

2019 ◽  
Vol 8 (4) ◽  
pp. 443 ◽  
Author(s):  
Young Kim ◽  
Yoosoo Chang ◽  
Yejin Kim ◽  
Soo Kim ◽  
Eun-Jung Rhee ◽  
...  
Keyword(s):  
Cohort Study ◽  
Thyroid Dysfunction ◽  
Fdg Uptake ◽  
Increased Risk ◽  
Pet Ct ◽  
Thyroid Uptake ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

The impact of incidentally identified diffuse thyroid FDG uptake on 18F-FDG PET/CT scan on the incidence of thyroid dysfunction remains unclear. We examined the association of diffuse thyroid FDG uptake with the development of thyroid dysfunction. This cohort study involved 39,098 Korean adults who were free of malignancy and thyroid disease at baseline and underwent regular health checkup examinations including an 18F-FDG whole body PET/CT scan, thyroid-stimulating hormone and free thyroxine. The participants were annually or biennially followed for up to 5 years. A parametric proportional hazard model was used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI). Diffuse thyroid uptake was positively associated with increased risk of thyroid dysfunction in both the cross-sectional and cohort studies. During 104,261.4 person-years of follow-up, 102 incident hypothyroidism cases and 172 hyperthyroidism cases were identified. Multivariable-adjusted HR (95% CI) for incident hypothyroidism or hyperthyroidism comparing diffuse thyroid uptake to no uptake were 15.72 (9.23–26.77) and 7.38 (4.23–12.87), respectively. In this large cohort, incidentally, identified diffuse thyroid uptake on 18F-FDG PET/CT was associated with increased risk of both prevalent and incident thyroid dysfunction. Therefore, baseline and follow-up evaluations in individuals with diffuse thyroid uptake may help identify individuals with thyroid dysfunction.

Sign in / Sign up

Export Citation Format

Share Document