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Vascular Plagues Assessment using 18FFluorodeoxyglucose (FDG) Positron Emission Tomography (PET) and Computed Tomography (CT) during contemporaneous imaging acquisition : a preliminary study Poster No.: C-2036 Congress: ECR 2014 Type: Scientific Exhibit Authors: A. J. Nordin , S. Shahruddin , F. F. Ahmad Saad , N. Abdul 1 2 1 1 1 1 1 2 Rahim , H. Hassan , S. Mustafa ; Serdang, Se/MY, Putrajaya/ MY Keywords: Extremities, Vascular, Arteries / Aorta, PET, CT, PET-CT, Molecular imaging, Arteriosclerosis, Metabolic disorders DOI: 10.1594/ecr2014/C-2036 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. 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Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 7 www.myESR.org Page 2 of 7 Aims and objectives Thousands of whole body PET CT studies are performed routinely for cancer staging and restaging . Each study imparts ionizing radiation exposure to patients between depending on the chosen CT protocol . Obviously , informations obtained at imaging should be maximally optimized for patient's benefit . The potential of contemporaneous whole body 18F FDG PET-CT study in detecting atherosclerosis is highlighted. The correlative findings between risk for developing cardiovascular disease , existence of atherosclerosis in medium and large size arteries and the imaging features on CT and PET were analyzed . Methods and materials 47 contigous oncology patients who presented for staging and restaging using whole body 18F-FDG PET CT was selected from the Centre for Diagnostic Nuclear Imaging of Putra University Malaysia . The past and present clinical history of risk factors in developing cardiovascular events were obtained from all patients including hypertension , diabetes mellitus and ischaemic heart disease . All clinical informations were recorded . Fasting blood sugar was obtained from all patients . All PETCT imaging studies were performed following standard protocol . Study was carried out using Siemens Truepoint ® Biograph 'TrueV ' comprising Lutetium Oxyorthosilicate (LSO) scintillator crystal camera and 64 slice MDCT. The characteristic features of atherosclerotic plagues on PET using Maximum Semiquantitative Uptake Value (SUVmax ) and CT using Hounsfield Unit (HU) were recorded from medium and large size arteries from the neck , thorax , abdomen and pelvis . The images were reviewed systematically. The maximum intensity projection (MIP) was first analyzed for adequacy of FDG uptake intensity. The distribution was threshold with highest activity within the bladder and or renal excretion.Several sites were selected for the purpose of selecting atheromatous plaque for evidence of hardening or calcification from CT (figure 1) and reactive inflammation from PET images (figure 2) within selected vessel including bilateral carotids, ascending, arch and descending aorta, the abdominal aorta at supra and infra renal locations and the iliac arteries. Reconstructed images were reviewed in coronal, trans axial, and sagital planes. The images were reviewed using CT looking for morphological changes in the wall of the arteries and PET looking for focal increase in 18F-FDG uptake. Focal changes detectable in any of the modalities were analyzed in detail. Data was tabulated and analyzed using SPSS version 19. Page 3 of 7 Images for this section: Fig. 1: Multiplanar images of PET , CT and fused PET CT demonstrating hard and soft plague in the left wall of the abdominal aorta at 4 o'clock position . There is no uptake of FDG indicated within the plague. Page 4 of 7 Results Majority (44.7%) of the studied group belongs to elderly age (>60 year old) while one quarter (25.5%) between age group of 41-50 and 51-60 years . Male predominant (59.6%). There were 152 studied plagues at different locations . There was significant correlation (p<0.005) between the CT features of hardening artherosclerotic plagues and medical history of diabetes mellitus , hypertension and hyperlipidemia. On PET , although the relationship is not significant , those who presented with high risk factors demonstrate higher FDG plague activity than those who are not at risk. The intensity of FDG uptake in plagues of normal and underweight subjects were found to be lower than in obese patient with significant correlation (p<0.05) . Images for this section: Fig. 2: Multiplanar view of PET , CT and fused PETCT demonstrating the usefulness of intravenous contrast media in highlighting soft plague along the wall of descending aorta best seen in coronal and sagittal views. Page 5 of 7 Fig. 3: Multiplanar view of PET , CT and PETCT images at the level of upper abdomen demonstrating non contrast enhancing images . The wall of aorta , lumen and plagues are difficult to be differentiated in comparison to figure 2 . Page 6 of 7 Conclusion Diagnostic imaging study using integrated whole body 18F-FDG PETCT can be optimized to demonstrate atherosclerotic plagues in medium and large size arteries with significant CT correlation in patients with high risk factor developing cardiovascular disease. This study provide a possible insight in identifying patients for further cardiovascular assessment . Personal information A Jalil completed his Medical Degree training at the age of 24 from the National University Malaysia and obtained his post graduate Masters Radiology certification from University Malaya , School of Medicine in 1996. He is the director for Centre of Excellence in Diagnostic Nuclear Imaging , Universiti Putra Malaysia . He has published more than 40 papers in reputed journals, chapters and books. He is serving as an editorial board member of repute international journals. He is also the Vice President for Nuclear Medicine and Molecular Imaging , College of Radiology , Academy Medicine Malaysia. A board member of Speciality Subcommittee Radiology for the National Specialist Register Malaysia. References 1. Shazreen Shaharuddin , Ahmad Zaid Fattah Azman , Katiza Haida Ali , Abdul Latif Mohamad , Fathinul Fikri Ahmad Saad , Abdul Jalil Nordin . Vulnerable plaque detection: The role of 18-fluorine fluorodeoxyglucose in identifying high risk patients Alexandria Journal of Medicine (2013) 49, 329-336 2.Ben-Haim , Kupzov Ela, Tamir Ela, Israel Ora. Evaluation of 18F-FDG uptake and arterial wall calcifications using 18F-FDG PET/CT. J Nucl Med 2004;45(11):1816-21. 3. Dunphy MP, Freiman A, Larson SM, Strauss HW. Association of vascular 18F FDG uptake with vascular calcification. J Nucl Med 2005;46(8):1278-84. Page 7 of 7