Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
Nuclear Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Ann Nucl Med. 2021 Oct;35(10):1136-1146. doi: 10.1007/s12149-021-01651-2. Epub 2021 Jul 17.
Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) are caused often by destabilization of non-flow limiting inflamed coronary artery plaques. F-fluorodeoxyglucose (FDG) uptake with positron emission tomography/computed tomography (PET/CT) reveals plaque inflammation, while intracoronary optical coherence tomography (OCT) reliably identifies morphological features of coronary instability, such as plaque rupture or erosion. We aimed to prospectively compare these two innovative biotechnologies in the characterization of coronary artery inflammation, which has never been attempted before.
OCT and FDG PET/CT were performed in 18 patients with single vessel coronary artery disease, treated by percutaneous coronary intervention (PCI) with stent implantation, divided into 2 groups: NSTEMI/UA (n = 10) and stable angina (n = 8) patients.
Plaque rupture/erosion recurred more frequently [100% vs 25%, p = 0.001] and FDG uptake was greater [TBR median 1.50 vs 0.87, p = 0.004] in NSTEMI/UA than stable angina patients. FDG uptake resulted greater in patients with than without plaque rupture/erosion [1.2 (0.86-1.96) vs 0.87 (0.66-1.07), p = 0.013]. Among NSTEMI/UA patients, no significant difference in FDG uptake was found between ruptured and eroded plaques. The highest FDG uptake values were found in ruptured plaques, belonging to patients with NSTEMI/UA. OCT and PET/CT agreed in 72% of patients [p = 0.018]: 100% of patients with plaque rupture/erosion and increased FDG uptake had NSTEMI/UA.
For the first time, we demonstrated that the correspondence between increased FDG uptake with PET/CT and morphology of coronary plaque instability at OCT is high.
非 ST 段抬高型心肌梗死（NSTEMI）和不稳定型心绞痛（UA）通常是由非限流性炎症冠状动脉斑块的不稳定引起的。正电子发射断层扫描/计算机断层扫描（PET/CT）中的 F-氟脱氧葡萄糖（FDG）摄取可显示斑块炎症，而冠状动脉光学相干断层扫描（OCT）可可靠地识别冠状动脉不稳定的形态特征，如斑块破裂或侵蚀。我们旨在前瞻性比较这两种创新生物技术在冠状动脉炎症特征描述中的作用，这在以前从未尝试过。
对 18 例单支血管病变行经皮冠状动脉介入治疗（PCI）支架植入术的患者进行 OCT 和 FDG PET/CT 检查，分为 2 组：NSTEMI/UA（n=10）和稳定型心绞痛（n=8）患者。
NSTEMI/UA 组斑块破裂/侵蚀的发生率更高[100%比 25%，p=0.001]，FDG 摄取更高[TBR 中位数 1.50 比 0.87，p=0.004]。与无斑块破裂/侵蚀的患者相比，有斑块破裂/侵蚀的患者 FDG 摄取更高[1.2（0.86-1.96）比 0.87（0.66-1.07），p=0.013]。在 NSTEMI/UA 患者中，破裂和侵蚀斑块之间的 FDG 摄取无显著差异。破裂斑块的 FDG 摄取最高，属于 NSTEMI/UA 患者。OCT 和 PET/CT 在 72%的患者中一致[p=0.018]：100%有斑块破裂/侵蚀和 FDG 摄取增加的患者均为 NSTEMI/UA。
我们首次证明，PET/CT 中 FDG 摄取增加与 OCT 显示的冠状动脉斑块不稳定形态之间的对应关系较高。
