title: Validation of FDG uptake in the arterial wall as an imaging biomarker of atherosclerotic plaques with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT).
abstract: OBJECTIVE
  From the literature, the prevalence of fluorodeoxyglucose (FDG) uptake in large artery atherosclerotic plaques shows great heterogeneity. We retrospectively reviewed 100 consecutive patients who underwent FDG-positron emission tomography-computed tomography (PET/CT) imaging of their whole body, to evaluate FDG uptake in the arterial wall.
  
  
  METHODS
  We retrospectively evaluated 100 whole-body PET-CT scans. The PET images coregistered with CT were reviewed for abnormal 18F-FDG uptake. The mean standard uptake value (SUV) was measured in regions of interest (ROIs). The prevalence of PET+ plaques was determined based on the qualitative PET review, used as the gold standard in a receiver-operating characteristic (ROC) curve analysis to determine an optimal threshold for the quantitative PET analysis.
  
  
  RESULTS
  The qualitative, visual assessment demonstrated FDG uptake in the arterial walls of 26 patients. A total of 85 slices exhibited FDG uptake within the arterial wall of 37 artery locations. 11, 17, and 2 patients exhibited FDG uptake within the wall of carotid arteries, of the aorta, and of the iliac arteries, respectively. Only 4 of the 26 patients had positive FDG uptake in more than one artery location. In terms of quantitative analysis, a threshold of 2.8 SUV was associated with a negative predictive value of 99.4% and a positive predictive value of 100% to predict qualitative PET+ plaques. A threshold of 1.8 SUV was associated with a negative predictive value of 100% and a positive predictive value of 99.4%. Area under the ROC curve was .839.
  
  
  CONCLUSIONS
  The prevalence of PET uptake in arterial walls in a consecutive population of asymptomatic patients is low and usually confined to one type of artery, and its clinical relevance in terms of vulnerability to ischemic events remains to be determined.
authors.affiliation: Department of Radiology, Neuroradiology Section, University of California, San Francisco, CA; Department of Neurology, Cerebrovascular Unit, Neurological Institute Carlo Besta, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Bucci
authors.forename: Carina Mari
authors.initials: CM
authors.lastname: Aparici
authors.forename: Randy
authors.initials: R
authors.lastname: Hawkins
authors.forename: Steve
authors.initials: S
authors.lastname: Bacharach
authors.forename: Carole
authors.initials: C
authors.lastname: Schrek
authors.forename: Suchun
authors.initials: S
authors.lastname: Cheng
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tong
authors.forename: Sandeep
authors.initials: S
authors.lastname: Arora
authors.forename: Eugenio
authors.initials: E
authors.lastname: Parati
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
mesh_terms: D000792:Angiography / Q000379:methods; D001158:Arteries / Q000000981:diagnostic imaging / Q000378:metabolism; D050197:Atherosclerosis / Q000175:diagnosis* / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D008954:Models, Biological; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014018:Tissue Distribution; D014057:Tomography, X-Ray Computed / Q000379:methods*; D051598:Whole Body Imaging / Q000379:methods
chemical_list: D015415:Biomarkers; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18