Imaging of inflamed and vulnerable plaque in coronary arteries with 18F-FDG PET/CT in patients with suppression of myocardial uptake using a low-carbohydrate, high-fat preparation.
PET/CT imaging with (18)F-FDG has been used to detect inflammation in carotid and aortic plaque; its use in detecting coronary plaque has been limited by avid (18)F-FDG uptake by the myocardium. We investigated whether (18)F-FDG PET/CT could be used to image inflammation in coronary arteries as a potential noninvasive method to detect vulnerable plaque.


METHODS
We retrospectively studied 32 patients treated for malignancy who underwent (18)F-FDG PET/CT and concomitant cardiac catheterization. As part of the recently described protocol, all patients were instructed to eat a low-carbohydrate, high-fat meal the night before and drink a vegetable oil drink the morning of the study. We reviewed the patients' baseline characteristics and their (18)F-FDG PET/CT scans for adequacy of myocardial uptake suppression and correlated the presence of angiographically apparent plaque with (18)F-FDG uptake in the major coronary arteries. Two independent observers assessed the angiographic images and (18)F-FDG PET scans.


RESULTS
A total of 95% of patients had 2 or more coronary disease risk factors, and 25% had unstable symptoms; 30% of index catheterizations resulted in intervention. In 20 of 32 patients (63%), myocardial suppression was good (12) or adequate (8). Inadequate suppression was due to self-reported dietary nonadherence. Patients with good, adequate, and poor suppression had maximal myocardial standardized uptake values of 2.8 +/- 0.7, 5.0 +/- 1.3, and 17.0 +/- 9.7, respectively. We identified (18)F-FDG uptake in 15 patients in 1 or more coronary segments. A trend to significance in correlation between presence of angiographic disease and signal in the vessel was observed (P = 0.07; 80 vessels examined). A total of 7 patients with significant coronary artery disease had aortic (18)F-FDG uptake.


CONCLUSIONS
In this retrospective study, we demonstrated the potential use of (18)F-FDG PET in imaging of inflammation in coronary arteries. The potential of (18)F-FDG PET is also being investigated in a prospective study.
Wykrzykowska
Joanna
J
Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Lehman
Sanaz
S
Williams
Gethin
G
Parker
J Anthony
JA
Palmer
Matthew R
MR
Varkey
Santosh
S
Kolodny
Gerald
G
Laham
Roger
R
D001167:Arteritis / Q000175:diagnosis* / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000378:metabolism*; D050528:Diet, Carbohydrate-Restricted / Q000379:methods; D004041:Dietary Fats / Q000493:pharmacokinetics; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D009206:Myocardium / Q000378:metabolism; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D004041:Dietary Fats; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18