title: Potential of integrated [18F] fluorodeoxyglucose positron-emission tomography/CT in identifying vulnerable carotid plaques.
abstract: OBJECTIVE
  There is a need for improved risk stratification of patients with TIA/stroke and carotid atherosclerosis. The purpose of this study was to prospectively investigate the potential of integrated (18)F-FDG PET/MDCT in identifying vulnerable carotid plaques.
  
  
  METHODS
  Fifty patients with TIA/stroke with an ipsilateral carotid plaque causing <70% stenosis and a plaque on the contralateral asymptomatic side underwent integrated (18)F-FDG PET/MDCT within 36.1 ± 20.0 days (range, 9-95 days) of the last symptoms. Carotid plaque (18)F-FDG uptake was measured as both the mean and maximum blood-normalized SUV, known as the TBR. Using MDCT, we assessed volumes of vessel wall and individual plaque components.
  
  
  RESULTS
  Mean TBR was only significantly larger in the ipsilateral plaques of patients who were imaged within 38 days (1.24 ± 0.04 [SE] versus 1.17 ± 0.05, P = .014). This also accounted for maximum TBR (1.53 ± 0.06 versus 1.42 ± 0.06, P = .015). MDCT-assessed vessel wall and LRNC volumes were larger in ipsilateral plaques of all patients (982.3 ± 121.3 versus 811.3 ± 106.6 mm(3), P = .016; 164.7 ± 26.1 versus 134.3 ± 35.2 mm(3), P = .026, respectively).
  
  
  CONCLUSIONS
  In the present study, (18)F-FDG PET only detected significant differences between ipsilateral and contralateral asymptomatic plaques in patients with TIA/stroke who were imaged within 38 days, whereas MDCT detected larger vessel wall and LRNC volumes, regardless of time after symptoms. In view of the substantial overlap in measurements of both sides, it remains to be determined whether the differences we found will be clinically meaningful.
authors.affiliation: Department of Radiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands.
authors.forename: R M
authors.initials: RM
authors.lastname: Kwee
authors.forename: M T B
authors.initials: MT
authors.lastname: Truijman
authors.forename: W H
authors.initials: WH
authors.lastname: Mess
authors.forename: G J J
authors.initials: GJ
authors.lastname: Teule
authors.forename: J W M
authors.initials: JW
authors.lastname: ter Berg
authors.forename: C L
authors.initials: CL
authors.lastname: Franke
authors.forename: A G G C
authors.initials: AG
authors.lastname: Korten
authors.forename: B J
authors.initials: BJ
authors.lastname: Meems
authors.forename: M H
authors.initials: MH
authors.lastname: Prins
authors.forename: J M A
authors.initials: JM
authors.lastname: van Engelshoven
authors.forename: J E
authors.initials: JE
authors.lastname: Wildberger
authors.forename: R J
authors.initials: RJ
authors.lastname: van Oostenbrugge
authors.forename: M E
authors.initials: ME
authors.lastname: Kooi
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology*; D013382:Subtraction Technique; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18