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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
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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.
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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.
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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.
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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 .
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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.
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