High-risk Plaque Features Can Be Detected in Non-stenotic Carotid Plaques of Patients with Ischaemic Stroke Classified As Cryptogenic Using Combined (18)F-FDG PET/MR Imaging

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2015 Oct 5

PMID 26433367

Citations 50

Authors

Fabien Hyafil

Andreas Schindler

Dominik Sepp

Tilman Obenhuber

Anna Bayer-Karpinska

Tobias Boeckh-Behrens

Sabine Hohn

Marcus Hacker

Stephan G Nekolla

Axel Rominger

Martin Dichgans

Markus Schwaiger

Tobias Saam

Holger Poppert

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to investigate in 18 patients with ischaemic stroke classified as cryptogenic and presenting non-stenotic carotid atherosclerotic plaques the morphological and biological aspects of these plaques with magnetic resonance imaging (MRI) and (18)F-fluoro-deoxyglucose positron emission tomography ((18)F-FDG PET) imaging.

Methods: Carotid arteries were imaged 150 min after injection of (18)F-FDG with a combined PET/MRI system. American Heart Association (AHA) lesion type and plaque composition were determined on consecutive MRI axial sections (n = 460) in both carotid arteries. (18)F-FDG uptake in carotid arteries was quantified using tissue to background ratio (TBR) on corresponding PET sections.

Results: The prevalence of complicated atherosclerotic plaques (AHA lesion type VI) detected with high-resolution MRI was significantly higher in the carotid artery ipsilateral to the ischaemic stroke as compared to the contralateral side (39 vs 0 %; p = 0.001). For all other AHA lesion types, no significant differences were found between ipsilateral and contralateral sides. In addition, atherosclerotic plaques classified as high-risk lesions with MRI (AHA lesion type VI) were associated with higher (18)F-FDG uptake in comparison with other AHA lesions (TBR = 3.43 ± 1.13 vs 2.41 ± 0.84, respectively; p < 0.001). Furthermore, patients presenting at least one complicated lesion (AHA lesion type VI) with MRI showed significantly higher (18)F-FDG uptake in both carotid arteries (ipsilateral and contralateral to the stroke) in comparison with carotid arteries of patients showing no complicated lesion with MRI (mean TBR = 3.18 ± 1.26 and 2.80 ± 0.94 vs 2.19 ± 0.57, respectively; p < 0.05) in favour of a diffuse inflammatory process along both carotid arteries associated with complicated plaques.

Conclusion: Morphological and biological features of high-risk plaques can be detected with (18)F-FDG PET/MRI in non-stenotic atherosclerotic plaques ipsilateral to the stroke, suggesting a causal role for these plaques in stroke. Combined (18)F-FDG PET/MRI systems might help in the evaluation of patients with ischaemic stroke classified as cryptogenic.

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References

Delso G, Furst S, Jakoby B, Ladebeck R, Ganter C, Nekolla S . Performance measurements of the Siemens mMR integrated whole-body PET/MR scanner. J Nucl Med. 2011; 52(12):1914-22. DOI: 10.2967/jnumed.111.092726. View

Rominger A, Saam T, Wolpers S, Cyran C, Schmidt M, Foerster S . 18F-FDG PET/CT identifies patients at risk for future vascular events in an otherwise asymptomatic cohort with neoplastic disease. J Nucl Med. 2009; 50(10):1611-20. DOI: 10.2967/jnumed.109.065151. View

Saam T, Raya J, Cyran C, Bochmann K, Meimarakis G, Dietrich O . High resolution carotid black-blood 3T MR with parallel imaging and dedicated 4-channel surface coils. J Cardiovasc Magn Reson. 2009; 11:41. PMC: 2773764. DOI: 10.1186/1532-429X-11-41. View

Hatsukami T, Ross R, Polissar N, Yuan C . Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation. 2000; 102(9):959-64. DOI: 10.1161/01.cir.102.9.959. View

Amarenco P . Underlying pathology of stroke of unknown cause (cryptogenic stroke). Cerebrovasc Dis. 2009; 27 Suppl 1:97-103. DOI: 10.1159/000200446. View

Krishnamurthi R, Feigin V, Forouzanfar M, Mensah G, Connor M, Bennett D . Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2014; 1(5):e259-81. PMC: 4181351. DOI: 10.1016/S2214-109X(13)70089-5. View

Marnane M, Merwick A, Sheehan O, Hannon N, Foran P, Grant T . Carotid plaque inflammation on 18F-fluorodeoxyglucose positron emission tomography predicts early stroke recurrence. Ann Neurol. 2012; 71(5):709-18. DOI: 10.1002/ana.23553. View

Tang T, Howarth S, Miller S, Graves M, U-King-Im J, Li Z . Comparison of the inflammatory burden of truly asymptomatic carotid atheroma with atherosclerotic plaques in patients with asymptomatic carotid stenosis undergoing coronary artery bypass grafting: an ultrasmall superparamagnetic iron oxide enhanced.... Eur J Vasc Endovasc Surg. 2008; 35(4):392-8. DOI: 10.1016/j.ejvs.2007.10.019. View

Schwaiger M, Ziegler S, Nekolla S . PET/CT challenge for the non-invasive diagnosis of coronary artery disease. Eur J Radiol. 2010; 73(3):494-503. DOI: 10.1016/j.ejrad.2009.12.025. View

10.

Rudd J, Warburton E, Fryer T, Jones H, Clark J, Antoun N . Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation. 2002; 105(23):2708-11. DOI: 10.1161/01.cir.0000020548.60110.76. View

11.

Kerwin W, Xu D, Liu F, Saam T, Underhill H, Takaya N . Magnetic resonance imaging of carotid atherosclerosis: plaque analysis. Top Magn Reson Imaging. 2007; 18(5):371-8. DOI: 10.1097/rmr.0b013e3181598d9d. View

12.

Rudd J, Myers K, Bansilal S, Machac J, Pinto C, Tong C . Atherosclerosis inflammation imaging with 18F-FDG PET: carotid, iliac, and femoral uptake reproducibility, quantification methods, and recommendations. J Nucl Med. 2008; 49(6):871-8. DOI: 10.2967/jnumed.107.050294. View

13.

Go A, Mozaffarian D, Roger V, Benjamin E, Berry J, Blaha M . Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2013; 129(3):e28-e292. PMC: 5408159. DOI: 10.1161/01.cir.0000441139.02102.80. View

14.

Naghavi M, Libby P, Falk E, Casscells S, Litovsky S, Rumberger J . From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. Circulation. 2003; 108(15):1772-8. DOI: 10.1161/01.CIR.0000087481.55887.C9. View

15.

Figueroa A, Subramanian S, Cury R, Truong Q, Gardecki J, Tearney G . Distribution of inflammation within carotid atherosclerotic plaques with high-risk morphological features: a comparison between positron emission tomography activity, plaque morphology, and histopathology. Circ Cardiovasc Imaging. 2011; 5(1):69-77. DOI: 10.1161/CIRCIMAGING.110.959478. View

16.

Martinez-Moller A, Souvatzoglou M, Delso G, Bundschuh R, Chefdhotel C, Ziegler S . Tissue classification as a potential approach for attenuation correction in whole-body PET/MRI: evaluation with PET/CT data. J Nucl Med. 2009; 50(4):520-6. DOI: 10.2967/jnumed.108.054726. View

17.

Kwee R, Truijman M, Mess W, Teule G, ter Berg J, Franke C . Potential of integrated [18F] fluorodeoxyglucose positron-emission tomography/CT in identifying vulnerable carotid plaques. AJNR Am J Neuroradiol. 2011; 32(5):950-4. PMC: 7965558. DOI: 10.3174/ajnr.A2381. View

18.

. Risk of stroke in the distribution of an asymptomatic carotid artery. The European Carotid Surgery Trialists Collaborative Group. Lancet. 1995; 345(8944):209-12. View

19.

Adams R, Albers G, Alberts M, Benavente O, Furie K, Goldstein L . Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2008; 39(5):1647-52. PMC: 4198335. DOI: 10.1161/STROKEAHA.107.189063. View

20.

Silvera S, El Aidi H, Rudd J, Mani V, Yang L, Farkouh M . Multimodality imaging of atherosclerotic plaque activity and composition using FDG-PET/CT and MRI in carotid and femoral arteries. Atherosclerosis. 2009; 207(1):139-43. PMC: 3436906. DOI: 10.1016/j.atherosclerosis.2009.04.023. View