Arauz Antonio, Hoyos Leticia, Zenteno Marco, Mendoza Raul, Alexanderson Erik
Stroke Clinic of the Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
Clin Neurol Neurosurg. 2007 Jun;109(5):409-12. doi: 10.1016/j.clineuro.2007.02.012. Epub 2007 Apr 5.
Inflammation is important in both the pathogenesis and outcome of atherosclerosis. Current imaging techniques provide anatomic data but no indication of plaque inflammation. We tested the hypothesis that plaque inflammation could be assessed in vivo by (18)FDG-PET and that plaque inflammation could increase the risk of recurrent vascular events and poor response to treatment in a pilot study.
Thirteen patients (median age 66.1 years [55-82 years]) with recent carotid territory TIA or ischemic stroke and internal carotid artery (ICA) stenosis > or =50% were studied. Angiography and (18)F-fluorodeoxyglucose-positron emission tomography ((18)FDG-PET) imaging were carried out in all patients. Treatment for carotid stenosis in each patient was selected by the attending physician and consisted in medical treatment, endarterectomy or stent placement. During 6 months of follow-up, the specific end points assessed were the occurrence of any stroke, death, or re-stenosis.
Patients with symptomatic carotid atherosclerosis were imaged using (18)FDG-PET. Strong (18)FDG uptake (SUV> or =2.7) was seen in 11 of 13 (85%) carotid lesions. Among these patients two died during follow-up, 3 had recurrent non-fatal ipsilateral ischemic stroke and 1 patient who had undergone stenting had non-symptomatic re-stenosis in control studies. There was a significant correlation between the (18)FDG uptake and degree of ICA stenosis detected by angiography.
Carotid atherosclerotic plaques contain a variable degree of inflammation which can be assessed in vivo by means of FDG and PET. The prognostic value of this marker is, however, still unclear and needs further study.
炎症在动脉粥样硬化的发病机制和转归中均起重要作用。目前的成像技术可提供解剖学数据，但无法显示斑块炎症情况。在一项初步研究中，我们检验了以下假设：可通过（18）FDG-PET在体内评估斑块炎症，且斑块炎症会增加复发性血管事件的风险及降低治疗反应。
研究了13例近期有颈动脉供血区短暂性脑缺血发作（TIA）或缺血性卒中且颈内动脉（ICA）狭窄≥50%的患者（中位年龄66.1岁[55 - 82岁]）。所有患者均接受了血管造影和（18）F-氟脱氧葡萄糖正电子发射断层扫描（（18）FDG-PET）成像。每位患者的颈动脉狭窄治疗方案由主治医师选定，包括药物治疗、内膜切除术或支架置入术。在6个月的随访期间，评估的特定终点为任何卒中、死亡或再狭窄的发生情况。
对有症状的颈动脉粥样硬化患者进行了（18）FDG-PET成像。13个颈动脉病变中有11个（85%）可见强烈的（18）FDG摄取（标准化摄取值≥2.七分）。在这些患者中，2例在随访期间死亡，3例发生复发性非致命性同侧缺血性卒中，1例接受支架置入术的患者在对照研究中出现无症状再狭窄。（18）FDG摄取与血管造影检测到的ICA狭窄程度之间存在显著相关性。
颈动脉粥样硬化斑块含有不同程度的炎症，可通过FDG和PET在体内进行评估。然而，该标志物的预后价值仍不明确，需要进一步研究。
