title: 18FDG-PET-CT: an imaging biomarker of high-risk carotid plaques. Correlation to symptoms and microembolic signals.
abstract: OBJECTIVE
  We investigated whether uptake of (18)fluoro-2-deoxy-d-glucose (18FDG) positron emission tomography-computed tomography (PET-CT) correlated to clinical symptoms and presence of microembolic signals (MES) detected by transcranial Doppler in patients with carotid stenosis.
  
  
  METHODS
  18FDG-PET-CT and MES detection was performed in consecutive patients with 50% to 99% symptomatic or asymptomatic carotid stenoses. Uptake index was defined by a target to background ratio (TBR) between maximum standardized uptake value of the carotid plaque and the mean standardized uptake value of the jugular veins. End points for analysis were presence of symptoms and presence of MES.
  
  
  RESULTS
  We included 123 stenosis derived from 110 patients, 60 symptomatic and 63 asymptomatic. MES positive (+) lesions were found in 16%. TBR values were higher in symptomatic compared with asymptomatic (median 2.07 versus 1.78; P<0.0018) and in MES+ compared with MES- plaques (median 2.14 versus 1.86; P<0.008). TBR values were also higher in asymptomatic MES+ compared with MES- plaques (median 1.97 versus 1.76; P<0.03). The best TBR threshold value for symptomatic versus asymptomatic, for MES+ versus MES-, for symptomatic MES+ versus symptomatic or asymptomatic MES-, and for asymptomatic MES+ versus asymptomatic MES- plaques was 1.9. Sensitivity/specificity were, respectively, 56/77%, 73/63%, 79/64%, and 80/77%. We found a strong correlation between number of MES and TBR values (ρ 0.26; P=0.0043).
  
  
  CONCLUSIONS
  18FDG-PET-CT accurately detected high-risk carotid plaques. Also given its strong correlation to MES, 18FDG-PET-CT may be a useful tool in clinical practice.
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.). hubertus.muller@hcuge.ch.
authors.forename: Hubertus Fritz Georg
authors.initials: HF
authors.lastname: Müller
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
authors.forename: Aurélien
authors.initials: A
authors.lastname: Viaccoz
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
authors.forename: Loraine
authors.initials: L
authors.lastname: Fisch
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
authors.forename: Christophe
authors.initials: C
authors.lastname: Bonvin
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
authors.forename: Karl-Olof
authors.initials: KO
authors.lastname: Lovblad
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
authors.forename: Osman
authors.initials: O
authors.lastname: Ratib
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
authors.forename: Patrice
authors.initials: P
authors.lastname: Lalive
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
authors.forename: Sabrina
authors.initials: S
authors.lastname: Pagano
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
authors.forename: Nicolas
authors.initials: N
authors.lastname: Vuilleumier
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Willi
authors.affiliation: From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
authors.forename: Roman
authors.initials: R
authors.lastname: Sztajzel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016893:Carotid Stenosis / Q000175:diagnosis*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: brain imaging; carotid plaque; carotid stenosis; imaging; stroke; vascular occlusion