Carotid plaque inflammation on 18F-fluorodeoxyglucose positron emission tomography predicts early stroke recurrence
Carotid plaque inflammation on 18F-fluorodeoxyglucose positron emission tomography predicts early stroke recurrence
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DOI：
10.1002/ana.23553
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发表时间：
2012-05-01
影响因子：
11.2
通讯作者：
Kelly, Peter J.
中科院分区：
文献类型：
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作者：
Marnane, Michael;Merwick, Aine;Kelly, Peter J.
目的：与其他卒中亚型相比，症状性颈动脉狭窄与早期卒中复发风险相关3倍。目前的颈动脉成像技术依赖于估计斑块相关的管腔狭窄，但不评估斑块内炎症，斑块内炎症是斑块破裂和血栓栓塞症的关键介质。采用18F-脱氧葡萄糖正电子发射断层扫描(FDG-PET)/计算机断层扫描相结合的方法，研究炎症相关FDG摄取与卒中复发的关系。方法：连续入选近期(中位数6.5天；四分位数范围4-8天)卒中、短暂性脑缺血发作(TIA)、视网膜血栓和同侧颈动脉狭窄(>；=50%)的患者。FDG摄取量为平均标准摄取值(SUV，g/ml)。对患者进行前瞻性的中风复发跟踪调查。结果：60例患者中，卒中25例，短暂性脑缺血发作29例，视网膜栓塞6例。22%(13/60)的患者在90天内中风复发。早期复发性卒中患者同侧颈动脉斑块中FDG摄取较高(平均SUV为1.85g/ml；标准差为0.44vs1.58g/ml；标准差为0.32，p<0.02)。在生命表分析中，平均SUV大于2.14g/ml阈值的90天复发率为80%(95%可信区间[CI]，41.8-99.2)与22.9%(95%可信区间，12.3-40.3)(SUV=70%)，平均斑块FDG摄取是卒中复发的唯一独立预测因素(调整后的危险比，6.1；95%可信区间，1.3-28.8；p0.02)。解释：在最近有症状的颈动脉狭窄中，炎症相关的FDG摄取与早期卒中复发有关，与狭窄程度无关。斑块FDG-PET可以确定中风复发风险最高的患者，这些患者可能会被选为立即血运重建或强化治疗的对象。Ann Neurol 2012；71：709-718
Objective: Symptomatic carotid stenosis is associated with a 3-fold risk of early stroke recurrence compared to other stroke subtypes. Current carotid imaging techniques rely on estimating plaque-related lumen narrowing but do not evaluate intraplaque inflammation, a key mediator of plaque rupture and thromboembolism. Using combined 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET)/computed tomography, we investigated the relation between inflammation-related FDG uptake and stroke recurrence. Methods: Consecutive patients with a recent (median, 6.5 days; interquartile range, 4-8) stroke, transient ischemic attack (TIA), or retinal embolism and ipsilateral carotid stenosis (>= 50%) were included. FDG uptake was quantified as mean standardized uptake values (SUVs, g/ ml). Patients were followed prospectively for stroke recurrence. Results: Sixty patients were included (25 stroke, 29 TIA, 6 retinal embolism). Twenty-two percent (13 of 60) had stroke recurrence within 90 days. FDG uptake in ipsilateral carotid plaque was greater in patients with early recurrent stroke (mean SUV, 1.85g/ ml; standard deviation [SD], 0.44 vs 1.58g/ ml; SD, 0.32, p 0.02). On life-table analysis, 90-day recurrence rates with mean SUV greater than a 2.14g/ ml threshold were 80% (95% confidence interval [CI], 41.8-99.2) versus 22.9% (95% CI, 12.3-40.3) with SUV = 70%), mean plaque FDG uptake was the only independent predictor of stroke recurrence (adjusted hazard ratio, 6.1; 95% CI, 1.3-28.8; p 0.02). Interpretation: In recently symptomatic carotid stenosis, inflammation-related FDG uptake was associated with early stroke recurrence, independent of the degree of stenosis. Plaque FDG-PET may identify patients at highest risk for stroke recurrence, who may be selected for immediate revascularization or intensive medical treatment. ANN NEUROL 2012; 71: 709-718