Vesey Alex T, Jenkins William S A, Irkle Agnese, Moss Alastair, Sng Greg, Forsythe Rachael O, Clark Tim, Roberts Gemma, Fletcher Alison, Lucatelli Christophe, Rudd James H F, Davenport Anthony P, Mills Nicholas L, Al-Shahi Salman Rustam, Dennis Martin, Whiteley William N, van Beek Edwin J R, Dweck Marc R, Newby David E
From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.T.V., W.S.A.J., A.M., G.S., R.O.F., N.L.M., E.J.R.v.B., M.R.D., D.E.N.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.I., J.R., A.P.D.); and Clinical Research Imaging Centre (T.C., G.R., A.F., C.L., E.J.R.v.B., M.R.D., D.E.N.) and Centre for Clinical Brain Sciences (R.A.-S.S., M.D., W.W.), University of Edinburgh, United Kingdom.
Circ Cardiovasc Imaging. 2017 Mar;10(3):e004976. doi: 10.1161/CIRCIMAGING.116.004976.
Combined positron emission tomography (PET) and computed tomography (CT) can assess both anatomy and biology of carotid atherosclerosis. We sought to assess whether F-fluoride or F-fluorodeoxyglucose can identify culprit and high-risk carotid plaque.
We performed F-fluoride and F-fluorodeoxyglucose PET/CT in 26 patients after recent transient ischemic attack or minor ischemic stroke: 18 patients with culprit carotid stenosis awaiting carotid endarterectomy and 8 controls without culprit carotid atheroma. We compared standardized uptake values in the clinically adjudicated culprit to the contralateral asymptomatic artery, and assessed the relationship between radiotracer uptake and plaque phenotype or predicted cardiovascular risk (ASSIGN score [Assessing Cardiovascular Risk Using SIGN Guidelines to Assign Preventive Treatment]). We also performed micro PET/CT and histological analysis of excised plaque. On histological and micro PET/CT analysis, F-fluoride selectively highlighted microcalcification. Carotid F-fluoride uptake was increased in clinically adjudicated culprit plaques compared with asymptomatic contralateral plaques (logstandardized uptake value 0.29±0.10 versus 0.23±0.11, =0.001) and compared with control patients (logstandardized uptake value 0.29±0.10 versus 0.12±0.11, =0.001). F-Fluoride uptake correlated with high-risk plaque features (remodeling index [=0.53, =0.003], plaque burden [=0.51, =0.004]), and predicted cardiovascular risk [=0.65, =0.002]). Carotid F-fluorodeoxyglucose uptake appeared to be increased in 7 of 16 culprit plaques, but no overall differences in uptake were observed in culprit versus contralateral plaques or control patients. However, F-fluorodeoxyglucose did correlate with predicted cardiovascular risk (=0.53, =0.019), but not with plaque phenotype.
F-Fluoride PET/CT highlights culprit and phenotypically high-risk carotid plaque. This has the potential to improve risk stratification and selection of patients who may benefit from intervention.
正电子发射断层扫描（PET）与计算机断层扫描（CT）相结合可评估颈动脉粥样硬化的解剖结构和生物学特性。我们旨在评估¹⁸F - 氟化物或¹⁸F - 氟脱氧葡萄糖是否能够识别罪犯斑块和高危颈动脉斑块。
我们对26例近期发生短暂性脑缺血发作或轻度缺血性卒中的患者进行了¹⁸F - 氟化物和¹⁸F - 氟脱氧葡萄糖PET/CT检查：18例患有罪犯颈动脉狭窄并等待颈动脉内膜切除术的患者以及8例无罪犯颈动脉粥样硬化的对照者。我们将经临床判定的罪犯斑块与对侧无症状动脉的标准化摄取值进行比较，并评估放射性示踪剂摄取与斑块表型或预测的心血管风险（ASSIGN评分[使用SIGN指南评估心血管风险以分配预防性治疗]）之间的关系。我们还对切除的斑块进行了微型PET/CT和组织学分析。在组织学和微型PET/CT分析中，¹⁸F - 氟化物选择性地突出显示了微钙化。与无症状的对侧斑块相比（标准化摄取值对数0.29±0.10对0.23±0.11，P = 0.001）以及与对照患者相比（标准化摄取值对数0.29±0.10对0.12±0.11，P = 0.001），经临床判定的罪犯颈动脉斑块中¹⁸F - 氟化物摄取增加。¹⁸F - 氟化物摄取与高危斑块特征（重塑指数[r = 0.53，P = 0.003]、斑块负荷[r = 0.51，P = 0.004]）相关，并可预测心血管风险[r = 0.65，P = 0.002]）。16例罪犯斑块中有7例¹⁸F - 氟脱氧葡萄糖摄取似乎增加，但在罪犯斑块与对侧斑块或对照患者之间未观察到摄取的总体差异。然而，¹⁸F - 氟脱氧葡萄糖确实与预测的心血管风险相关（r = 0.53，P = 0.019），但与斑块表型无关。
¹⁸F - 氟化物PET/CT可突出显示罪犯斑块和表型高危颈动脉斑块。这有可能改善风险分层并选择可能从干预中获益的患者。
