Feasibility of FDG Imaging of the Coronary Arteries Comparison Between Acute Coronary Syndrome and Stable Angina

Harvard University, Cambridge, Massachusetts, United States
JACC. Cardiovascular imaging (Impact Factor: 7.19). 04/2010; 3(4):388-97. DOI: 10.1016/j.jcmg.2010.01.004
Source: PubMed


This study tested the hypothesis that fluorodeoxyglucose (FDG) uptake within the ascending aorta and left main coronary artery (LM), measured using positron emission tomography (PET), is greater in patients with recent acute coronary syndrome (ACS) than in patients with stable angina.
Inflammation is known to play an important role in atherosclerosis. Positron emission tomography imaging with (18)F-FDG provides a measure of plaque inflammation.
Twenty-five patients (mean age 57.9 +/- 9.8 years, 72% male, 10 ACS, and 15 stable angina) underwent cardiac computed tomographic angiography and PET imaging with (18)F-FDG after invasive angiography. Images were coregistered, and FDG uptake was measured at locations of interest for calculation of target-to-background ratios (TBR). Additionally, FDG uptake was measured at the site of the lesion deemed clinically responsible for the presenting syndrome (culprit) by virtue of locating the stent deployed to treat the syndrome.
The FDG uptake was higher in the ACS versus the stable angina groups in the ascending aorta (median [interquartile ranges] TBR 3.30 [2.69 to 4.12] vs. 2.43 [2.00 to 2.86], p = 0.02), as well as the LM (2.48 [2.30 to 2.93] vs. 2.00 [1.71 to 2.44], p = 0.03, respectively). The TBR was greater for culprit lesions associated with ACS than for lesions stented for stable coronary syndromes (2.61 vs. 1.74, p = 0.02). Furthermore, the TBR in the stented lesions (in ACS and stable angina groups) correlated with C-reactive protein (r = 0.58, p = 0.04).
This study shows that in patients with recent ACS, FDG accumulation is increased both within the culprit lesion as well as in the ascending aorta and LM. This observation suggests inflammatory activity within atherosclerotic plaques in acute coronary syndromes and supports intensification of efforts to refine PET methods for molecular imaging of coronary plaques.

Download full-text


Available from: Ricardo C Cury, Sep 07, 2015
  • Source
    • "Coronary imaging remains challenging with PET or other currently available imaging modalities due to small size, constant motion, and in the case of 18F-FDG, obscuring uptake by adjacent myocardium [14]. Although 18F-FDG uptake is a marker for viable myocardium, this myocardial uptake makes it harder to image the adjacent small-sized coronaries [32], though there are some promising initial results [33]. This makes an intravascular imaging approach advantageous, minimizing the distance and maximizing the sensitivity to coronary plaque signal. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Atherosclerosis is a progressive inflammatory condition that underlies coronary artery disease (CAD)–the leading cause of death in the United States. Thus, the ultimate goal of this research is to advance our understanding of human CAD by improving the characterization of metabolically active vulnerable plaques within the coronary arteries using a novel catheter-based imaging system. The aims of this study include (1) developing a novel fiber-optic imaging system with a scintillator to detect both 18F and fluorescent glucose probes, and (2) validating the system on ex vivo murine plaques.
    Full-text · Article · Sep 2014 · PLoS ONE
  • Source
    • "A major drawback of imaging coronary atherosclerosis with FDG-PET, however, is the lack of specificity of the tracer, and another limitation is the high uptake of FDG in the myocardium, which produces a suboptimal signal-to-noise ratio. Consequently, in contrast to FDG imaging of carotid plaques, few studies have utilized FDG-PET to image coronary atherosclerosis [41•, 42]. One recent retrospective study indicated a potential future role of arterial FDG-PET in risk stratification of asymptomatic patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with peripheral artery disease are at high risk of coronary artery disease. An increasing number of studies show that a large proportion of patients with peripheral artery disease have significant coronary atherosclerosis, even in the absence of symptoms. Although the reported prevalence of subclinical coronary artery disease varies widely in patients with peripheral artery disease, it could include more than half of patients. No consensus exists to date on either the rationale for screening patients with peripheral artery disease for coronary atherosclerosis or the optimal algorithm and method for screening. An increasing number of imaging modalities are emerging that allow improved in vivo non-invasive characterization of atherosclerotic plaques. These novel imaging methods may lead to early detection of high-risk vulnerable plaques, enabling clinicians to improve risk stratification of patients with peripheral artery disease, and thus paving the way for individualized therapy.
    Full-text · Article · Jun 2014 · Current Atherosclerosis Reports
  • Source
    • "Human carotid arteries that are implicated in stroke have shown an increased uptake of 18 F-FDG (Rudd et al., 2002). In addition, increased uptake has also been observed in patients with acute coronary syndromes (Rogers et al., 2010). FDG-PET/CT is therefore increasingly used as a marker to assess metabolically active atherosclerotic plaques, as well as to assess the therapeutic efficacy of antiatherosclerosis drugs (Rudd et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Nanomedicine can provide a potent alternative to current therapeutic strategies for atherosclerosis. For example, the encapsulation of anti-inflammatory drugs into liposomes improves their pharmacokinetics and biodistribution, thereby enhancing bioavailability to atherosclerotic plaques and improving therapeutic efficacy. The evaluation of this type of experimental therapeutics can greatly benefit from in vivo evaluation to assess biological changes, which can be performed by non-invasive imaging techniques, such as ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). Here, we will illustrate the methods for inducing atherosclerosis in a rabbit model, the production of anti-inflammatory liposomes and monitoring of therapeutic efficacy of experimental therapeutics with the above-mentioned imaging techniques.
    Full-text · Article · Dec 2012 · Methods in enzymology
Show more