In vivo 18F-fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflammation in patients
In vivo 18F-fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflammation in patients
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DOI：
10.1016/j.jacc.2006.05.076
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发表时间：
2006-11-07
影响因子：
24
通讯作者：
Fischman, Alan J.
中科院分区：
文献类型：
--
作者：
Tawakol, Ahmed;Migrino, Raymond Q.;Fischman, Alan J.
考虑到炎症在动脉粥样硬化中的重要性，我们试图确定是否可以使用正电子发射断层扫描（PET）在人类中无创地测量动脉粥样硬化斑块炎症。背景早期使用氟脱氧葡萄糖（FDG）的PET研究表明，动脉粥样硬化斑块中FDG摄取增加。在这里，我们测试的能力，FDG-PET测量颈动脉斑块炎症的患者随后接受颈动脉内膜切除术（CEA）。方法17例严重颈动脉狭窄FDG给药（13至25 mCi）后3小时进行FDG-PET成像后，颈动脉斑块FDG摄取被确定为斑块与血液活性的比率（目标背景比，TBR）。成像后不到1个月，受试者进行CEA，之后处理颈动脉标本以识别巨噬细胞（抗CD 68抗体染色）。结果颈动脉斑块的PET信号与相应组织切片的巨噬细胞染色之间存在显著相关性（r = 0.70; p < 0.0001）。当将17名患者的平均FDG摄取（平均TBR）与平均炎症（平均CD 68染色百分比）进行比较时，相关性甚至更强（r = 0.85; p < 0.0001）。氟脱氧葡萄糖摄取与斑块面积，斑块厚度，或面积的平滑肌细胞staining.CONCLUSIONS我们建立了FDG-PET成像可用于评估患者颈动脉斑块炎症的严重程度。如果随后的自然史研究将颈动脉FDG-PET活性增加与临床事件联系起来，则这种非侵入性测量可用于识别需要强化药物治疗或颈动脉介入以预防卒中的颈动脉粥样硬化患者子集。
OBJECTIVES Given the importance of inflammation in atherosclerosis, we sought to determine if atherosclerotic plaque inflammation could be measured noninvasively in humans using positron emission tomography (PET).BACKGROUND Earlier PET studies using fluorodeoxyglucose (FDG) demonstrated increased FDG uptake in atherosclerotic plaques. Here we tested the ability of FDG-PET to measure carotid plaque inflammation in patients who subsequently underwent carotid endarterectomy (CEA).METHODS Seventeen patients with severe carotid stenoses underwent FDG-PET imaging 3 h after FDG administration (13 to 25 mCi), after which carotid plaque FDG uptake was determined as the ratio of plaque to blood activity (target to background ratio, TBR). Less than 1 month after imaging, subjects underwent CEA, after which carotid specimens were processed to identify macrophages (staining with anti-CD68 antibodies).RESULTS There was a significant correlation between the PET signal from the carotid plaques and the macrophage staining from the corresponding histologic sections (r = 0.70; p < 0.0001). When mean FDG uptake (mean TBR) was compared with mean inflammation (mean percentage CD68 staining) for each of the 17 patients, the correlation was even stronger (r = 0.85; p < 0.0001). Fluorodeoxyglucose uptake did not correlate with plaque area, plaque thickness, or area of smooth muscle cell staining.CONCLUSIONS We established that FDG-PET imaging can be used to assess the severity of inflammation in carotid plaques in patients. If subsequent natural history studies link increased FDG-PET activity in carotid arteries with clinical events, this noninvasive measure could be used to identify a subset of patients with carotid atherosclerosis in need of intensified medical therapy or carotid artery intervention to prevent stroke.