Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Atherosclerosis. 2010 Aug;211(2):371-80. doi: 10.1016/j.atherosclerosis.2010.01.002. Epub 2010 Feb 1.
Imaging atherosclerosis may help to identify subjects harboring rupture-prone atherosclerotic plaques who may benefit from preventive interventions. Potential of plaques to rupture depends on their structural changes and metabolic activation, which are difficult to assess using anatomic imaging modalities. Recent studies suggested that functional imaging with positron emission tomography (PET) utilizing fluorine-18-labeled 2-deoxy-d-glucose (FDG) has the potential to assess plaque metabolism and add to prediction of vascular risk. Aortic, iliac, and carotid plaques can be detected with FDG-PET, even though not all plaques exhibit high FDG uptake. Detection of coronary artery plaques is more cumbersome due to technical limitations of PET and fast movement of these vessels during cardiac and respiratory cycles. Studies on substrate accumulating FDG in plaques are contradictory and mostly do not extend beyond correlation analyses. Vascular FDG uptake has an excellent short-term stability, but larger fluctuations of uptake long-term, which may complicate interpretation of such changes in therapeutic trials. FDG uptake in major arteries correlates with some cardiovascular risk factors and atherosclerosis markers, but clinical utility of such correlations is unclear. What is more important is that recently reported studies in cancer patients showed correlation between higher baseline FDG uptake and subsequent cardiovascular mortality. Anti-atherogenic therapy and therapeutic lifestyle changes seem to decrease vascular FDG uptake but it is not clear whether the latter predicts subsequent lower morbidity and mortality. These initial findings suggest that vascular FDG-PET may in the future find some utility in management of patients with atherosclerosis, but a number of important issues need to be addressed first. We need to: (1) determine optimal standard ways of performing imaging and quantifying vascular FDG uptake; (2) understand molecular mechanisms governing FDG accumulation in plaques; (3) perform studies prospectively linking vascular FDG uptake to cardiovascular events in non-cancer patients. As of today, vascular FDG-PET is not ready for its prime time in clinical practice.
影像学检查动脉粥样硬化有助于识别易发生破裂的动脉粥样硬化斑块的患者，这些患者可能受益于预防性干预。斑块破裂的可能性取决于其结构变化和代谢激活，而这些变化使用解剖成像方式很难评估。最近的研究表明，利用氟-18 标记的 2-脱氧-d-葡萄糖（FDG）的正电子发射断层扫描（PET）进行功能成像有可能评估斑块的代谢，并增加对血管风险的预测。即使不是所有的斑块都有高 FDG 摄取，FDG-PET 也可以检测到主动脉、髂动脉和颈动脉斑块。由于 PET 的技术限制以及这些血管在心脏和呼吸周期中的快速运动，检测冠状动脉斑块更加麻烦。关于斑块中积累 FDG 的底物的研究存在矛盾，并且大多数研究仅限于相关性分析。血管 FDG 摄取具有极好的短期稳定性，但长期摄取的波动较大，这可能使治疗试验中此类变化的解释复杂化。主要动脉的 FDG 摄取与一些心血管危险因素和动脉粥样硬化标志物相关，但这种相关性的临床应用尚不清楚。更重要的是，最近在癌症患者中的研究报告显示，较高的基线 FDG 摄取与随后的心血管死亡率之间存在相关性。抗动脉粥样硬化治疗和治疗性生活方式的改变似乎可以降低血管 FDG 摄取，但尚不清楚后者是否可以预测随后的发病率和死亡率降低。这些初步发现表明，血管 FDG-PET 可能在未来的动脉粥样硬化患者管理中找到一些应用，但首先需要解决一些重要问题。我们需要：（1）确定执行血管 FDG 摄取成像和定量的最佳标准方法；（2）了解控制斑块中 FDG 积累的分子机制；（3）前瞻性地进行研究，将血管 FDG 摄取与非癌症患者的心血管事件联系起来。截至目前，血管 FDG-PET 还没有准备好进入临床实践的黄金时期。
