Hubertus Fritz Georg Müller1, Aurélien Viaccoz2, Loraine Fisch2, Christophe Bonvin2, Karl-Olof Lovblad2, Osman Ratib2, Patrice Lalive2, Sabrina Pagano2, Nicolas Vuilleumier2, Jean-Pierre Willi2, Roman Sztajzel2. 1. 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. 2. 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.).
Abstract
BACKGROUND AND PURPOSE: 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.
BACKGROUND AND PURPOSE: 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: Mohammed M Chowdhury; Jason M Tarkin; Nicholas R Evans; Elizabeth Le; Elizabeth A Warburton; Paul D Hayes; James H F Rudd; Patrick A Coughlin Journal: Eur J Vasc Endovasc Surg Date: 2018-05-02 Impact factor: 7.069