18F-FDG PET/CT Identifies Patients at Risk for Future Vascular Events in an Otherwise Asymptomatic Cohort with Neoplastic Disease
18F-FDG PET/CT Identifies Patients at Risk for Future Vascular Events in an Otherwise Asymptomatic Cohort with Neoplastic Disease
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DOI：
10.2967/jnumed.109.065151
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发表时间：
2009-10-01
影响因子：
9.3
通讯作者：
Hacker, Marcus
中科院分区：
文献类型：
--
作者：
Rominger, Axel;Saam, Tobias;Hacker, Marcus
我们的目的是评估动脉F-18-FDG摄取和F-18-FDG PET/CT检测的大动脉钙化与随后无症状癌症患者血管事件发生的关系。方法：对932例肿瘤患者进行F-18-FDG全身PET/CT检查，获得临床随访资料（中位随访时间29个月）。在该队列中，279名患者死于肿瘤疾病。932例患者中有15例（1.6%）发生了血管事件，定义为缺血性卒中、心肌梗死或血运重建术。最大标准化摄取值（SUV）除以血池SUV，得到每个动脉段的目标-背景比（TBR）。计算主要血管（升、降、腹主动脉、主动脉弓、髂动脉和颈动脉）的平均TBR以及每位患者的钙化斑块总和评分。结果：平均TBR与钙化斑块总数有显著相关性（P < 0.001）。尽管钙化斑块总量与血管事件的所有常规危险因素显著相关，但平均TBR仅与年龄、男性和高血压相关。Cox回归风险模型确定平均TBR >= 1.7和钙化斑块总和>= 15为血管事件发生的独立预测因子。平均TBR和钙化斑块均高于这些阈值的患者被认为未来发生血管事件的风险最高。然而，平均TBR >= 1.7比钙化斑块>= 15具有更大的预后价值。结论：在一个大型癌症患者队列中，大动脉中F-18-FDG摄取增加是随后血管事件的最强预测因子。伴随的严重血管钙化似乎具有特别高的风险。鉴于本研究的发生率很小，需要对无癌症患者进行更大规模的前瞻性试验来证实这些有希望的结果。
Our objective was to evaluate the association of arterial F-18-FDG uptake and calcifications in large arteries as detected by F-18-FDG PET/CT with the subsequent occurrence of vascular events in otherwise asymptomatic cancer patients. Methods: Clinical follow-up information was obtained for 932 cancer patients examined with whole-body F-18-FDG PET/CT ( median follow-up time, 29 mo). Among this cohort, 279 patients had died from their oncologic disease. In 15 of 932 patients (1.6%), a vascular event, defined as ischemic stroke, myocardial infarction, or revascularization, was registered. The maximal standardized uptake value (SUV) was divided by the blood-pool SUV, yielding a target-to-background ratio (TBR) for each arterial segment. The mean TBR as well as a calcified plaque sum score per patient were calculated in the major vessels: ascending, descending, and abdominal aorta, aortic arch, as well as iliac and carotid arteries. Results: A significant correlation was observed between mean TBR and calcified plaque sum (P < 0.001). Although calcified plaque sum significantly correlated with all conventional risk factors for vascular events, mean TBR correlated only with age, the male sex, and hypertension. The Cox regression hazard model identified a mean TBR >= 1.7 and a calcified plaque sum >= 15 as independent predictors for the occurrence of a vascular event. Patients with both mean TBR and calcified plaque sum above these thresholds were identified as having the highest risk for a future vascular event. However, a mean TBR >= 1.7 had greater prognostic value than did a calcified plaque sum >= 15. Conclusion: In a large cohort of cancer patients, increased F-18-FDG uptake in major arteries emerged as the strongest predictor of a subsequent vascular event. Concomitant severe vascular calcifications seemed to impart a particularly high risk. Given the small event rate in the present study, larger, prospective trials of patients without cancer are required to substantiate these promising results.