Inflammation as a Predictor of Abdominal Aortic Aneurysm Growth and Rupture: A Systematic Review of Imaging Biomarkers.
Methods are required to identify abdominal aortic aneurysms (AAAs) at increased risk of rupture. Inflammatory characteristics of AAA can be visualised using advanced imaging techniques and have been proposed as potential predictors of aneurysm progression. The objective of this review was to determine which inflammatory imaging biomarkers are associated with AAA growth and rupture.



A systematic review was carried out in accordance with the PRISMA guidelines. The electronic databases of Medline (PubMed), Embase, and the Cochrane Library were searched up to January 1, 2016 for studies to determine the potential association between inflammatory imaging biomarkers and AAA growth or rupture.



Seven studies were included, comprising 202 AAA patients. (18)F-fluoro-deoxy-glucose positron emission tomography ((18)F-FDG PET-CT) was evaluated in six studies. Magnetic resonance imaging with ultrasmall superparamagnetic particles of iron oxide (USPIO-MRI) was evaluated in one study. Two of six (18)F-FDG PET-CT studies reported a significant negative correlation (r=.383, p = .015) or a significant negative association (p = .04). Four of six (18)F-FDG PET-CT studies reported no significant association between (18)F-FDG uptake and AAA growth. The single study investigating USPIO-MRI demonstrated that AAA growth was three times higher in patients with focal USPIO uptake in the AAA wall compared to patients with diffuse or no USPIO uptake in the wall (0.66 vs. 0.24 vs. 0.22 cm/y, p = .020). In the single study relating (18)F-FDG uptake results to AAA rupture, the association was not significant.



Current evidence shows contradictory associations between (18)F-FDG uptake and AAA growth. Data on the association with rupture are insufficient. Based on the currently available evidence, neither (18)F-FDG PET-CT nor USPIO-MRI can be implemented as growth or rupture prediction tools in daily practice. The heterogeneous results reflect the complex and partially unclear relationship between inflammatory processes and AAA progression.
Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
H
H
Jalalzadeh
Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
R
R
Indrakusuma
Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
R N
RN
Planken
Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
D A
DA
Legemate
Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
M J W
MJ
Koelemay
Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: r.balm@amc.nl.
R
R
Balm
D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging*; D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000209:etiology; D001025:Aortitis / Q000150:complications / Q000000981:diagnostic imaging*; D001027:Aortography / Q000379:methods*; D000072226:Computed Tomography Angiography; D003287:Contrast Media; D003911:Dextrans; D018450:Disease Progression; D019788:Fluorodeoxyglucose F18; D006801:Humans; D018810:Magnetic Resonance Angiography; D058185:Magnetite Nanoparticles; D057054:Molecular Imaging / Q000379:methods*; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors
D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D019275:Radiopharmaceuticals; C097921:ferumoxtran-10; D019788:Fluorodeoxyglucose F18
Abdominal; Aneurysm; Aortic aneurysm; Biomarkers; Diagnostic imaging; Growth; Inflammation; Ruptured