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Blanchard I, Vootukuru N, Bhattaru A, Patil S, Rojulpote C. PET Radiotracers in Atherosclerosis: A Review. Curr Probl Cardiol 2023; 48:101925. [PMID: 37392979 DOI: 10.1016/j.cpcardiol.2023.101925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
Traditional atherosclerosis imaging modalities are limited to late stages of disease, prior to which patients are frequently asymptomatic. Positron emission tomography (PET) imaging allows for the visualization of metabolic processes underscoring disease progression via radioactive tracer, allowing earlier-stage disease to be identified. 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG) uptake largely reflects the metabolic activity of macrophages, but is unspecific and limited in its utility. By detecting areas of microcalcification, 18F-Sodium Fluoride (18F-NaF) uptake also provides insight into atherosclerosis pathogenesis. Gallium-68 DOTA-0-Tyr3-Octreotate (68Ga-DOTATATE) PET has also shown potential in identifying vulnerable atherosclerotic plaques with high somatostatin receptor expression. Finally, 11-carbon (11C)-choline and 18F-fluoromethylcholine (FMCH) tracers may identify high-risk atherosclerotic plaques by detecting increased choline metabolism. Together, these radiotracers quantify disease burden, assess treatment efficacy, and stratify risk for adverse cardiac events.
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Affiliation(s)
| | - Nishita Vootukuru
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Abhijit Bhattaru
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ; Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | - Chaitanya Rojulpote
- Department of Radiology, University of Pennsylvania, Philadelphia, PA; Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA.
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Advances in the Assessment of Coronary Artery Disease Activity with PET/CT and CTA. Tomography 2023; 9:328-341. [PMID: 36828378 PMCID: PMC9962109 DOI: 10.3390/tomography9010026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Non-invasive testing plays a pivotal role in the diagnosis, assessment of progression, response to therapy, and risk stratification of coronary artery disease. Although anatomical plaque imaging by computed tomography angiography (CTA) and ischemia detection with myocardial perfusion imaging studies are current standards of care, there is a growing body of evidence that imaging of the processes which drive atherosclerotic plaque progression and rupture has the potential to further enhance risk stratification. In particular, non-invasive imaging of coronary plaque inflammation and active calcification has shown promise in this regard. Positron emission tomography (PET) with newly-adopted radiotracers provides unique insights into atheroma activity acting as a powerful independent predictor of myocardial infarctions. Similarly, by providing a quantitative measure of coronary inflammation, the pericoronary adipose tissue density (PCAT) derived from standard coronary CTA enhances cardiac risk prediction and allows re-stratification over and above current state-of-the-art assessments. In this review, we shall discuss the recent advances in the non-invasive methods of assessment of disease activity by PET and CTA, highlighting how these methods could improve risk stratification and ultimately benefit patients with coronary artery disease.
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Kwiecinski J. Novel PET Applications and Radiotracers for Imaging Cardiovascular Pathophysiology. Cardiol Clin 2023; 41:129-139. [PMID: 37003671 DOI: 10.1016/j.ccl.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
PET allows the assessment of cardiovascular pathophysiology across a wide range of cardiovascular conditions. By imaging processes directly involved in disease progression and adverse events, such as inflammation and developing calcifications (microcalcifications), PET can not only enhance our understanding of cardiovascular disease, but also, as shown for 18F-sodium fluoride, has the potential to predict hard endpoints. In this review, the recent advances in disease activity assessment with cardiovascular PET, which provide hope that this promising technology could be leveraged in the clinical setting, shall be discussed.
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Affiliation(s)
- Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, KKiAI, Institute of Cardiology, Alpejska 42, Warsaw 04-628, Poland.
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4
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Yang W, Zhong Z, Feng G, Wang Z. Advances in positron emission tomography tracers related to vascular calcification. Ann Nucl Med 2022; 36:787-797. [PMID: 35834116 DOI: 10.1007/s12149-022-01771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022]
Abstract
Microcalcification, a type of vascular calcification, increases the instability of plaque and easily leads to acute clinical events. Positron emission tomography (PET) is a new examination technology with significant advantages in identifying vascular calcification, especially microcalcification. The use of the 18F-NaF is undoubtedly the benchmark, and other PET tracers related to vascular calcification are also currently in development. Despite all this, a large number of studies are still needed to further clarify the specific mechanisms and characteristics. This review aimed at providing a summary of the application and progress of different PET tracers and also the future development direction.
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Affiliation(s)
- Wenjun Yang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Zhiqi Zhong
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Guoquan Feng
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China.
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Ciappuccini R, Saguet-Rysanek V, Dorbeau M, Lequesne J, Linard C, Lefevre-Arbogast S, Clarisse B, Bardet S. Thyroid 18F-fluorocholine uptake in patients with chronic autoimmune thyroiditis. Eur Thyroid J 2022; 11:e220025. [PMID: 35583185 PMCID: PMC9254274 DOI: 10.1530/etj-22-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objective 18F-Fluorocholine (18FCH) PET/CT has high sensitivity for parathyroid adenoma detection and can reliably exclude malignancy in thyroid nodules with indeterminate cytology. Data regarding 18FCH uptake in chronic autoimmune thyroiditis (CAT) are scarce. We aimed to assess thyroid 18FCH uptake in CAT with biological and histological correlation. Methods This is an ancillary study from the Chocolate trial (NCT02784223) that prospectively enrolled 107 patients planned for thyroid surgery. 18FCH PET/CT acquisitions were performed 20 and 60 min after injection. 18FCH uptake in the thyroid gland was assessed by measuring maximum (SUVmax) and mean (SUVmean) standardized uptake values. Thyrotropin, free thyroxine (FT4), thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies were collected. The intensity of thyroiditis and the degree of fibrosis were assessed on pathology. Results CAT was evidenced in 19/107 (18%) patients. Of these, 13 (68%) displayed an increased and diffuse 18FCH thyroid uptake. This uptake pattern was not observed in patients without CAT. SUVmax and SUVmean were higher in patients with CAT than in those without (P < 0.001). At both acquisition times, SUVmax showed a monotonic relationship with the intensity of thyroiditis (Spearman ρ = 0.44 and 0.51, respectively, P < 0.001) and with the degree of fibrosis (Spearman ρ = 0.55 and 0.62, respectively, P < 0.001). SUVmax showed a linear relationship with TPOAb titers at 20 min (Pearson r = 0.54, P < 0.05; Spearman ρ = 0.59, P = 0.03). Conclusions More than two-thirds of the patients with CAT present high and diffuse thyroid 18FCH uptake. This uptake pattern is highly specific to CAT and is correlated with pathology and TPOAb titers.
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Affiliation(s)
- Renaud Ciappuccini
- Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, Caen, France
- INSERM 1086 ANTICIPE, Caen University, Caen, France
| | | | - Marine Dorbeau
- Department of Pathology, François Baclesse Cancer Centre, Caen, France
| | - Justine Lequesne
- Department of Clinical Research, François Baclesse Cancer Centre, Caen, France
| | - Camille Linard
- Department of Pathology, François Baclesse Cancer Centre, Caen, France
| | | | - Bénédicte Clarisse
- Department of Clinical Research, François Baclesse Cancer Centre, Caen, France
| | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, Caen, France
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Park SM, Kim J, Baek S, Jeon JY, Lee SJ, Kang SY, Yoo MY, Yoon HJ, Kwon SH, Lim K, Oh SJ, Kim BS, Lee KP, Moon BS. Feasibility of 18F-Fluorocholine PET for Evaluating Skeletal Muscle Atrophy in a Starved Rat Model. Diagnostics (Basel) 2022; 12:diagnostics12051274. [PMID: 35626428 PMCID: PMC9141294 DOI: 10.3390/diagnostics12051274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 12/25/2022] Open
Abstract
Imaging techniques for diagnosing muscle atrophy and sarcopenia remain insufficient, although various advanced diagnostic methods have been established. We explored the feasibility of 18F-fluorocholine (18F-FCH) positron emission tomography/computed tomography (PET/CT) for evaluating skeletal muscle atrophy, as an imaging technique that tracks choline level changes in muscles. Cell uptake in L6 cells by 18F-FCH was performed in a complete medium containing serum (untreated group, UN) and a serum-free medium (starved group, ST). Small-animal-dedicated PET/CT imaging with 18F-FCH was examined in in-vivo models with rats that were starved for 2 days to cause muscle atrophy. After the hind limbs were dissected, starvation-induced in-vivo models were anatomically confirmed by reverse-transcription polymerase chain reaction to evaluate the expression levels of the atrophy markers muscle RING-finger protein-1 (MuRF-1) and atrogin-1. 18F-FCH uptake was lower in the starvation-induced cells than in the untreated group, and in-vivo PET uptake also revealed a similar tendency (the average standardized uptake value (SUVmean) = 0.26 ± 0.06 versus 0.37 ± 0.07, respectively). Furthermore, the expression levels of MuRF-1 and atrogin-1 mRNA were significantly increased in the starvation-induced muscle atrophy of rats compared to the untreated group. 18F-FCH PET/CT may be a promising tool for diagnosing skeletal muscle atrophy.
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Affiliation(s)
- Sun Mi Park
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul 07804, Korea; (S.M.P.); (S.Y.K.)
| | - Jisu Kim
- Physical Activity and Performance Institute, Konkuk University, Seoul 05029, Korea; (J.K.); (K.L.)
| | - Suji Baek
- Research and Development Center, UMUST R&D Corporation, Seoul 01411, Korea;
| | - Joo-Yeong Jeon
- Seoul Center, Korean Basic Science Institute, Seoul 02841, Korea; (J.-Y.J.); (S.H.K.)
| | - Sang Ju Lee
- Department of Nuclear Medicine, College of Medicine, Asan Medical Center, University of Ulsan, Seoul 05505, Korea; (S.J.L.); (S.J.O.)
| | - Seo Young Kang
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul 07804, Korea; (S.M.P.); (S.Y.K.)
| | - Min Young Yoo
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul 07985, Korea; (M.Y.Y.); (H.-J.Y.)
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul 07985, Korea; (M.Y.Y.); (H.-J.Y.)
| | - Seung Hae Kwon
- Seoul Center, Korean Basic Science Institute, Seoul 02841, Korea; (J.-Y.J.); (S.H.K.)
| | - Kiwon Lim
- Physical Activity and Performance Institute, Konkuk University, Seoul 05029, Korea; (J.K.); (K.L.)
| | - Seung Jun Oh
- Department of Nuclear Medicine, College of Medicine, Asan Medical Center, University of Ulsan, Seoul 05505, Korea; (S.J.L.); (S.J.O.)
| | - Bom Sahn Kim
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul 07804, Korea; (S.M.P.); (S.Y.K.)
- Correspondence: (B.S.K.); (K.P.L.); (B.S.M.)
| | - Kang Pa Lee
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul 07804, Korea; (S.M.P.); (S.Y.K.)
- Research and Development Center, UMUST R&D Corporation, Seoul 01411, Korea;
- Correspondence: (B.S.K.); (K.P.L.); (B.S.M.)
| | - Byung Seok Moon
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul 07804, Korea; (S.M.P.); (S.Y.K.)
- Correspondence: (B.S.K.); (K.P.L.); (B.S.M.)
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Li XG, Velikyan I, Viitanen R, Roivainen A. PET radiopharmaceuticals for imaging inflammatory diseases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Prigent K, Vigne J. Advances in Radiopharmaceutical Sciences for Vascular Inflammation Imaging: Focus on Clinical Applications. Molecules 2021; 26:molecules26237111. [PMID: 34885690 PMCID: PMC8659223 DOI: 10.3390/molecules26237111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 01/18/2023] Open
Abstract
Biomedical imaging technologies offer identification of several anatomic and molecular features of disease pathogenesis. Molecular imaging techniques to assess cellular processes in vivo have been useful in advancing our understanding of several vascular inflammatory diseases. For the non-invasive molecular imaging of vascular inflammation, nuclear medicine constitutes one of the best imaging modalities, thanks to its high sensitivity for the detection of probes in tissues. 2-[18F]fluoro-2-deoxy-d-glucose ([18F]FDG) is currently the most widely used radiopharmaceutical for molecular imaging of vascular inflammatory diseases such as atherosclerosis and large-vessel vasculitis. The combination of [18F]FDG and positron emission tomography (PET) imaging has become a powerful tool to identify and monitor non-invasively inflammatory activities over time but suffers from several limitations including a lack of specificity and avid background in different localizations. The use of novel radiotracers may help to better understand the underlying pathophysiological processes and overcome some limitations of [18F]FDG PET for the imaging of vascular inflammation. This review examines how [18F]FDG PET has given us deeper insight into the role of inflammation in different vascular pathologies progression and discusses perspectives for alternative radiopharmaceuticals that could provide a more specific and simple identification of pathologies where vascular inflammation is implicated. Use of these novel PET tracers could lead to a better understanding of underlying disease mechanisms and help inform the identification and stratification of patients for newly emerging immune-modulatory therapies. Future research is needed to realize the true clinical translational value of PET imaging in vascular inflammatory diseases.
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Affiliation(s)
- Kevin Prigent
- CHU de Caen Normandie, Department of Nuclear Medicine, Normandie Université, UNICAEN, 14000 Caen, France;
| | - Jonathan Vigne
- CHU de Caen Normandie, Department of Nuclear Medicine, Normandie Université, UNICAEN, 14000 Caen, France;
- CHU de Caen Normandie, Department of Pharmacy, Normandie Université, UNICAEN, 14000 Caen, France
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), Normandie University, 14000 Caen, France
- Correspondence:
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Kondakov A, Lelyuk V. Clinical Molecular Imaging for Atherosclerotic Plaque. J Imaging 2021; 7:jimaging7100211. [PMID: 34677297 PMCID: PMC8538040 DOI: 10.3390/jimaging7100211] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Atherosclerosis is a well-known disease leading to cardiovascular events, including myocardial infarction and ischemic stroke. These conditions lead to a high mortality rate, which explains the interest in their prevention, early detection, and treatment. Molecular imaging is able to shed light on the basic pathophysiological processes, such as inflammation, that cause the progression and instability of plaque. The most common radiotracers used in clinical practice can detect increased energy metabolism (FDG), macrophage number (somatostatin receptor imaging), the intensity of cell proliferation in the area (labeled choline), and microcalcifications (fluoride imaging). These radiopharmaceuticals, especially FDG and labeled sodium fluoride, can predict cardiovascular events. The limitations of molecular imaging in atherosclerosis include low uptake of highly specific tracers, possible overlap with other diseases of the vessel wall, and specific features of certain tracers’ physiological distribution. A common protocol for patient preparation, data acquisition, and quantification is needed in the area of atherosclerosis imaging research.
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Mannes PZ, Tavakoli S. Imaging Immunometabolism in Atherosclerosis. J Nucl Med 2021; 62:896-902. [PMID: 33963045 PMCID: PMC8882876 DOI: 10.2967/jnumed.120.245407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
Over the past decade, there has been a growing recognition of the links between intracellular metabolism and immune cell activation, that is, immunometabolism, and its consequences in atherogenesis. However, most immunometabolic investigations have been conducted in cultured cells through pharmacologic or genetic manipulations of selected immunologic or metabolic pathways, limiting their extrapolation to the complex microenvironment of plaques. In vivo metabolic imaging is ideally situated to address this gap and to determine the clinical implications of immunometabolic alterations for diagnosis and management of patients. Indeed, 18F-FDG has been widely used in clinical studies with promising results for risk stratification of atherosclerosis and monitoring the response to therapeutic interventions, though the biologic basis of its uptake in plaques has been evolving. Herein, we describe recent advances in understanding of immunometabolism of atherosclerosis with an emphasis on macrophages, and we review promising metabolic imaging approaches using 18F-FDG and other PET radiotracers.
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Affiliation(s)
- Philip Z Mannes
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sina Tavakoli
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; .,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and.,Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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11
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Sriranjan RS, Tarkin JM, Evans NR, Le EPV, Chowdhury MM, Rudd JHF. Atherosclerosis imaging using PET: Insights and applications. Br J Pharmacol 2021; 178:2186-2203. [PMID: 31517992 DOI: 10.1111/bph.14868] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/02/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022] Open
Abstract
PET imaging is able to harness biological processes to characterise high-risk features of atherosclerotic plaque prone to rupture. Current radiotracers are able to track inflammation, microcalcification, hypoxia, and neoangiogenesis within vulnerable plaque. 18 F-fluorodeoxyglucose (18 F-FDG) is the most commonly used radiotracer in vascular studies and is employed as a surrogate marker of plaque inflammation. Increasingly, 18 F-FDG and other PET tracers are also being used to provide imaging endpoints in cardiovascular interventional trials. The evolution of novel PET radiotracers, imaging protocols, and hybrid scanners are likely to enable more efficient and accurate characterisation of high-risk plaque. This review explores the role of PET imaging in atherosclerosis with a focus on PET tracers utilised in clinical research and the applications of PET imaging to cardiovascular drug development.
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Affiliation(s)
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Nicholas R Evans
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Elizabeth P V Le
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | | | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
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12
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Lee R, Seok JW. An Update on [ 18F]Fluoride PET Imaging for Atherosclerotic Disease. J Lipid Atheroscler 2020; 9:349-361. [PMID: 33024730 PMCID: PMC7521973 DOI: 10.12997/jla.2020.9.3.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022] Open
Abstract
Atherosclerosis is the leading cause of life-threatening morbidity and mortality, as the rupture of atherosclerotic plaques leads to critical atherothrombotic events such as myocardial infarction and ischemic stroke, which are the 2 most common causes of death worldwide. Vascular calcification is a complicated pathological process involved in atherosclerosis, and microcalcifications are presumed to increase the likelihood of plaque rupture. Despite many efforts to develop novel non-invasive diagnostic modalities, diagnostic techniques are still limited, especially before symptomatic presentation. From this point of view, vulnerable plaques are a direct target of atherosclerosis imaging. Anatomic imaging modalities have the limitation of only visualizing macroscopic structural changes, which occurs in later stages of disease, while molecular imaging modalities are able to detect microscopic processes and microcalcifications, which occur early in the disease process. Na[18F]-fluoride positron emission tomography/computed tomography could allow the early detection of plaque instability, which is deemed to be a primary goal in the prevention of cardiac or brain ischemic events, by quantifying the microcalcifications within vulnerable plaques and evaluating the atherosclerotic disease burden.
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Affiliation(s)
- Reeree Lee
- Department of Nuclear Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Ju Won Seok
- Department of Nuclear Medicine, Chung-Ang University Hospital, Seoul, Korea
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13
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Multimodality Imaging of Aortic Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Ćorović A, Wall C, Mason JC, Rudd JHF, Tarkin JM. Novel Positron Emission Tomography Tracers for Imaging Vascular Inflammation. Curr Cardiol Rep 2020; 22:119. [PMID: 32772188 PMCID: PMC7415747 DOI: 10.1007/s11886-020-01372-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of Review To provide a focused update on recent advances in positron emission tomography (PET) imaging in vascular inflammatory diseases and consider future directions in the field. Recent Findings While PET imaging with 18F-fluorodeoxyglucose (FDG) can provide a useful marker of disease activity in several vascular inflammatory diseases, including atherosclerosis and large-vessel vasculitis, this tracer lacks inflammatory cell specificity and is not a practical solution for imaging the coronary vasculature because of avid background myocardial signal. To overcome these limitations, research is ongoing to identify novel PET tracers that can more accurately track individual components of vascular immune responses. Use of these novel PET tracers could lead to a better understanding of underlying disease mechanisms and help inform the identification and stratification of patients for newly emerging immune-modulatory therapies. Summary Future research is needed to realise the true clinical translational value of PET imaging in vascular inflammatory diseases.
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Affiliation(s)
- Andrej Ćorović
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Christopher Wall
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Justin C Mason
- Cardiovascular Division, National Heart & Lung Institute, Imperial College London, London, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK. .,Cardiovascular Division, National Heart & Lung Institute, Imperial College London, London, UK.
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Current Advances in the Diagnostic Imaging of Atherosclerosis: Insights into the Pathophysiology of Vulnerable Plaque. Int J Mol Sci 2020; 21:ijms21082992. [PMID: 32340284 PMCID: PMC7216001 DOI: 10.3390/ijms21082992] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis is a lipoprotein-driven inflammatory disorder leading to a plaque formation at specific sites of the arterial tree. After decades of slow progression, atherosclerotic plaque rupture and formation of thrombi are the major factors responsible for the development of acute coronary syndromes (ACSs). In this regard, the detection of high-risk (vulnerable) plaques is an ultimate goal in the management of atherosclerosis and cardiovascular diseases (CVDs). Vulnerable plaques have specific morphological features that make their detection possible, hence allowing for identification of high-risk patients and the tailoring of therapy. Plaque ruptures predominantly occur amongst lesions characterized as thin-cap fibroatheromas (TCFA). Plaques without a rupture, such as plaque erosions, are also thrombi-forming lesions on the most frequent pathological intimal thickening or fibroatheromas. Many attempts to comprehensively identify vulnerable plaque constituents with different invasive and non-invasive imaging technologies have been made. In this review, advantages and limitations of invasive and non-invasive imaging modalities currently available for the identification of plaque components and morphologic features associated with plaque vulnerability, as well as their clinical diagnostic and prognostic value, were discussed.
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16
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Molecular imaging of inflammation - Current and emerging technologies for diagnosis and treatment. Pharmacol Ther 2020; 211:107550. [PMID: 32325067 DOI: 10.1016/j.pharmthera.2020.107550] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022]
Abstract
Inflammation is a key factor in multiple diseases including primary immune-mediated inflammatory diseases e.g. rheumatoid arthritis but also, less obviously, in many other common conditions, e.g. cardiovascular disease and diabetes. Together, chronic inflammatory diseases contribute to the majority of global morbidity and mortality. However, our understanding of the underlying processes by which the immune response is activated and sustained is limited by a lack of cellular and molecular information obtained in situ. Molecular imaging is the visualization, detection and quantification of molecules in the body. The ability to reveal information on inflammatory biomarkers, pathways and cells can improve disease diagnosis, guide and monitor therapeutic intervention and identify new targets for research. The optimum molecular imaging modality will possess high sensitivity and high resolution and be capable of non-invasive quantitative imaging of multiple disease biomarkers while maintaining an acceptable safety profile. The mainstays of current clinical imaging are computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US) and nuclear imaging such as positron emission tomography (PET). However, none of these have yet progressed to routine clinical use in the molecular imaging of inflammation, therefore new approaches are required to meet this goal. This review sets out the respective merits and limitations of both established and emerging imaging modalities as clinically useful molecular imaging tools in addition to potential theranostic applications.
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Hyafil F, Vigne J. Imaging inflammation in atherosclerotic plaques: Just make it easy! J Nucl Cardiol 2019; 26:1705-1708. [PMID: 29700689 DOI: 10.1007/s12350-018-1289-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
The presence of inflammatory cells is a hallmark of unstable atherosclerotic plaques. Several imaging approaches have been developed for the noninvasive detection of inflammatory activities in atherosclerotic plaques. Positron emission tomography (PET) imaging with the injection of 18F-fluorodeoxyglucose (FDG) is currently the most widely used imaging technique to evaluate the density of activated macrophages in atherosclerotic plaques. Nevertheless, FDG-PET imaging has logistical and technical constraints that represent an important obstacle to the wider use of this approach for the evaluation of patients with atherosclerosis. In a similar way as in the oncological field, the balance between the benefits and costs of new drugs need to be improved in patients with cardiovascular diseases. PET imaging of plaque inflammation might represent a very useful tool to identify patients who could benefit the most from anti-inflammatory treatments and to exclude patients with other causes of inflammation who are the most likely to develop severe side effects under these drugs. The availability of radiotracers targeting more specifically inflammation in atherosclerotic plaques would greatly facilitate the logistic organization of this imaging and help to expand the use of PET for the evaluation of atherosclerotic patients.
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Affiliation(s)
- Fabien Hyafil
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Bichat, Assistance Publique - Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Inserm 1148, Université Paris Diderot, 46 rue Henri Huchard, 75018, Paris, France.
| | - Jonathan Vigne
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Bichat, Assistance Publique - Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Inserm 1148, Université Paris Diderot, 46 rue Henri Huchard, 75018, Paris, France
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18
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Vigne J, Thackeray J, Essers J, Makowski M, Varasteh Z, Curaj A, Karlas A, Canet-Soulas E, Mulder W, Kiessling F, Schäfers M, Botnar R, Wildgruber M, Hyafil F. Current and Emerging Preclinical Approaches for Imaging-Based Characterization of Atherosclerosis. Mol Imaging Biol 2019; 20:869-887. [PMID: 30250990 DOI: 10.1007/s11307-018-1264-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Atherosclerotic plaques can remain quiescent for years, but become life threatening upon rupture or disruption, initiating clot formation in the vessel lumen and causing acute myocardial infarction and ischemic stroke. Whether and how a plaque ruptures is determined by its macroscopic structure and microscopic composition. Rupture-prone plaques usually consist of a thin fibrous cap with few smooth muscle cells, a large lipid core, a dense infiltrate of inflammatory cells, and neovessels. Such lesions, termed high-risk plaques, can remain asymptomatic until the thrombotic event. Various imaging technologies currently allow visualization of morphological and biological characteristics of high-risk atherosclerotic plaques. Conventional protocols are often complex and lack specificity for high-risk plaque. Conversely, new imaging approaches are emerging which may overcome these limitations. Validation of these novel imaging techniques in preclinical models of atherosclerosis is essential for effective translational to clinical practice. Imaging the vessel wall, as well as its biological milieu in small animal models, is challenging because the vessel wall is a small structure that undergoes continuous movements imposed by the cardiac cycle as it is adjacent to circulating blood. The focus of this paper is to provide a state-of-the-art review on techniques currently available for preclinical imaging of atherosclerosis in small animal models and to discuss the advantages and limitations of each approach.
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Affiliation(s)
- Jonathan Vigne
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP; INSERM, U-1148, DHU FIRE, University Diderot, Paris, France
| | - James Thackeray
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Jeroen Essers
- Departments of Vascular Surgery, Molecular Genetics, Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands
| | - Marcus Makowski
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Zoreh Varasteh
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Adelina Curaj
- Institute for Molecular Cardiovascular Research (IMCAR), Institute for Experimental Molecular Imaging (ExMI), University Hospital Aachen, RWTH, Aachen, Germany
| | - Angelos Karlas
- Institute for Biological and Medical Imaging, Helmholtz Zentrum München, Oberschleissheim, Germany
| | - Emmanuel Canet-Soulas
- Laboratoire CarMeN, INSERM U-1060, Lyon/Hospices Civils Lyon, IHU OPERA Cardioprotection, Université de Lyon, Bron, France
| | - Willem Mulder
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai, New York, USA
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging (ExMI), University Hospital Aachen, RWTH, Aachen, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - René Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Moritz Wildgruber
- Translational Research Imaging Center, Institut für Klinische Radiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Fabien Hyafil
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP; INSERM, U-1148, DHU FIRE, University Diderot, Paris, France. .,Département de Médecine Nucléaire, Centre Hospitalier Universitaire Bichat, 46 rue Henri Huchard, 75018, Paris, France.
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19
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Lawal IO, Ankrah AO, Stoltz AC, Sathekge MM. Radionuclide imaging of inflammation in atherosclerotic vascular disease among people living with HIV infection: current practice and future perspective. Eur J Hybrid Imaging 2019; 3:5. [PMID: 34191183 PMCID: PMC8218042 DOI: 10.1186/s41824-019-0053-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/11/2019] [Indexed: 01/03/2023] Open
Abstract
People living with human immunodeficiency virus (HIV) infection have twice the risk of atherosclerotic vascular disease compared with non-infected individuals. Inflammation plays a critical role in the development and progression of atherosclerotic vascular disease. Therapies targeting inflammation irrespective of serum lipid levels have been shown to be effective in preventing the occurrence of CVD. Radionuclide imaging is a viable method for evaluating arterial inflammation. This evaluation is useful in quantifying CVD risk and for assessing the effectiveness of anti-inflammatory treatment. The most tested radionuclide method for quantifying arterial inflammation among people living with HIV infection has been with F-18 FDG PET/CT. The level of arterial uptake of F-18 FDG correlates with vascular inflammation and with the risk of development and progression of atherosclerotic disease. Several limitations exist to the use of F-18 FDG for PET quantification of arterial inflammation. Many targets expressed on macrophage, a significant player in arterial inflammation, have the potential for use in evaluating arterial inflammation among people living with HIV infection. The review describes the clinical utility of F-18 FDG PET/CT in assessing arterial inflammation as a risk for atherosclerotic disease among people living with HIV infection. It also outlines potential newer probes that may quantify arterial inflammation in the HIV-infected population by targeting different proteins expressed on macrophages.
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Affiliation(s)
- Ismaheel O. Lawal
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001 South Africa
| | - Alfred O. Ankrah
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001 South Africa
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen & University of Groningen, Groningen, The Netherlands
| | - Anton C. Stoltz
- Infectious Disease Unit, Department of Internal Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
| | - Mike M. Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001 South Africa
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20
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Bucerius J, Dijkgraaf I, Mottaghy FM, Schurgers LJ. Target identification for the diagnosis and intervention of vulnerable atherosclerotic plaques beyond 18F-fluorodeoxyglucose positron emission tomography imaging: promising tracers on the horizon. Eur J Nucl Med Mol Imaging 2018; 46:251-265. [PMID: 30302506 PMCID: PMC6267660 DOI: 10.1007/s00259-018-4176-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/18/2018] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease is the major cause of morbidity and mortality in developed countries and atherosclerosis is the major cause of cardiovascular disease. Atherosclerotic lesions obstruct blood flow in the arterial vessel wall and can rupture leading to the formation of occlusive thrombi. Conventional diagnostic tools are still of limited value for identifying the vulnerable arterial plaque and for predicting its risk of rupture and of releasing thromboembolic material. Knowledge of the molecular and biological processes implicated in the process of atherosclerosis will advance the development of imaging probes to differentiate the vulnerable plaque. The development of imaging probes with high sensitivity and specificity in identifying high-risk atherosclerotic vessel wall changes and plaques is crucial for improving knowledge-based decisions and tailored individual interventions. Arterial PET imaging with 18F-FDG has shown promising results in identifying inflammatory vessel wall changes in numerous studies and clinical trials. However, due to its limited specificity in general and its intense physiological uptake in the left ventricular myocardium that impair imaging of the coronary arteries, different PET tracers for the molecular imaging of atherosclerosis have been evaluated. This review describes biological, chemical and medical expertise supporting a translational approach that will enable the development of new or the evaluation of existing PET tracers for the identification of vulnerable atherosclerotic plaques for better risk prediction and benefit to patients.
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Affiliation(s)
- Jan Bucerius
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), 6229 HX, Maastricht, The Netherlands. .,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), 6200 MD, Maastricht, The Netherlands. .,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.
| | - Ingrid Dijkgraaf
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), 6200 MD, Maastricht, The Netherlands.,Department of Biochemistry, Maastricht University, Maastricht, The Netherlands
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), 6229 HX, Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Leon J Schurgers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), 6200 MD, Maastricht, The Netherlands. .,Department of Biochemistry, Maastricht University, Maastricht, The Netherlands.
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21
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Kim J, Song HC. Role of PET/CT in the Evaluation of Aortic Disease. Chonnam Med J 2018; 54:143-152. [PMID: 30288369 PMCID: PMC6165921 DOI: 10.4068/cmj.2018.54.3.143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 01/18/2023] Open
Abstract
Positron emission tomography (PET) /computed tomography (CT) has been established as a standard imaging modality in the evaluation of malignancy. Although PET/CT has played a major role in the management of oncology patients, its clinical use has also increased for various disorders other than malignancy. Growing evidence shows that PET/CT images have many advantages in aortic disease as well. This review article addresses the potential role of PET/CT in diseases involving the aorta, emphasizing its usefulness with regard to acute thoracic aortic syndromes, aortic aneurysm, atherosclerotic lesions, aortitis and aortic tumors.
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Affiliation(s)
- Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea.,Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Korea
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22
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18F-NaF and 18F-FDG as molecular probes in the evaluation of atherosclerosis. Eur J Nucl Med Mol Imaging 2018; 45:2190-2200. [PMID: 29978245 PMCID: PMC6182398 DOI: 10.1007/s00259-018-4078-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/21/2018] [Indexed: 12/12/2022]
Abstract
The early detection of atherosclerotic disease is vital to the effective prevention and management of life-threatening cardiovascular events such as myocardial infarctions and cerebrovascular accidents. Given the potential for positron emission tomography (PET) to visualize atherosclerosis earlier in the disease process than anatomic imaging modalities such as computed tomography (CT), this application of PET imaging has been the focus of intense scientific inquiry. Although 18F-FDG has historically been the most widely studied PET radiotracer in this domain, there is a growing body of evidence that 18F-NaF holds significant diagnostic and prognostic value as well. In this article, we review the existing literature on the application of 18F-FDG and 18F-NaF as PET probes in atherosclerosis and present the findings of original animal and human studies that have examined how well 18F-NaF uptake correlates with vascular calcification and cardiovascular risk.
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23
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Andrews JPM, Fayad ZA, Dweck MR. New methods to image unstable atherosclerotic plaques. Atherosclerosis 2018; 272:118-128. [PMID: 29602139 PMCID: PMC6463488 DOI: 10.1016/j.atherosclerosis.2018.03.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/06/2018] [Accepted: 03/09/2018] [Indexed: 12/11/2022]
Abstract
Atherosclerotic plaque rupture is the primary mechanism responsible for myocardial infarction and stroke, the top two killers worldwide. Despite being potentially fatal, the ubiquitous prevalence of atherosclerosis amongst the middle aged and elderly renders individual events relatively rare. This makes the accurate prediction of MI and stroke challenging. Advances in imaging techniques now allow detailed assessments of plaque morphology and disease activity. Both CT and MR can identify certain unstable plaque characteristics thought to be associated with an increased risk of rupture and events. PET imaging allows the activity of distinct pathological processes associated with atherosclerosis to be measured, differentiating patients with inactive and active disease states. Hybrid integration of PET with CT or MR now allows for an accurate assessment of not only plaque burden and morphology but plaque biology too. In this review, we discuss how these advanced imaging techniques hold promise in redefining our understanding of stable and unstable coronary artery disease beyond symptomatic status, and how they may refine patient risk-prediction and the rationing of expensive novel therapies.
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Affiliation(s)
- Jack P M Andrews
- Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, Royal Infirmary of Edinburgh, Edinburgh EH16 4SB, UK
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, Royal Infirmary of Edinburgh, Edinburgh EH16 4SB, UK
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24
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Fibrosis imaging: Current concepts and future directions. Adv Drug Deliv Rev 2017; 121:9-26. [PMID: 29108860 DOI: 10.1016/j.addr.2017.10.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 02/08/2023]
Abstract
Fibrosis plays an important role in many different pathologies. It results from tissue injury, chronic inflammation, autoimmune reactions and genetic alterations, and it is characterized by the excessive deposition of extracellular matrix components. Biopsies are routinely employed for fibrosis diagnosis, but they suffer from several drawbacks, including their invasive nature, sampling variability and limited spatial information. To overcome these limitations, multiple different imaging tools and technologies have been evaluated over the years, including X-ray imaging, computed tomography (CT), ultrasound (US), magnetic resonance imaging (MRI), positron emission tomography (PET) and single-photon emission computed tomography (SPECT). These modalities can provide anatomical, functional and molecular imaging information which is useful for fibrosis diagnosis and staging, and they may also hold potential for the longitudinal assessment of therapy responses. Here, we summarize the use of non-invasive imaging techniques for monitoring fibrosis in systemic autoimmune diseases, in parenchymal organs (such as liver, kidney, lung and heart), and in desmoplastic cancers. We also discuss how imaging biomarkers can be integrated in (pre-) clinical research to individualize and improve anti-fibrotic therapies.
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25
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TSPO PET Imaging: From Microglial Activation to Peripheral Sterile Inflammatory Diseases? CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:6592139. [PMID: 29114179 PMCID: PMC5632884 DOI: 10.1155/2017/6592139] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/01/2017] [Accepted: 08/07/2017] [Indexed: 02/07/2023]
Abstract
Peripheral sterile inflammatory diseases (PSIDs) are a heterogeneous group of disorders that gathers several chronic insults involving the cardiovascular, respiratory, gastrointestinal, or musculoskeletal system and wherein inflammation is the cornerstone of the pathophysiology. In PSID, timely characterization and localization of inflammatory foci are crucial for an adequate care for patients. In brain diseases, in vivo positron emission tomography (PET) exploration of inflammation has matured over the last 20 years, through the development of radiopharmaceuticals targeting the translocator protein-18 kDa (TSPO) as molecular biomarkers of activated microglia. Recently, TSPO has been introduced as a possible molecular target for PSIDs PET imaging, making this protein a potential biomarker to address disease heterogeneity, to assist in patient stratification, and to contribute to predicting treatment response. In this review, we summarized the major research advances recently made in the field of TSPO PET imaging in PSIDs. Promising preliminary results have been reported in bowel, cardiovascular, and rheumatic inflammatory diseases, consolidated by preclinical studies. Limitations of TSPO PET imaging in PSIDs, regarding both its large expression in healthy peripheral tissues, unlike in central nervous system, and the production of peripheral radiolabeled metabolites, are also discussed, regarding their possible consequences on TSPO PET signal's quantification.
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26
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Vöö S, Kwee RM, Sluimer JC, Schreuder FHBM, Wierts R, Bauwens M, Heeneman S, Cleutjens JPM, van Oostenbrugge RJ, Daemen JWH, Daemen MJAP, Mottaghy FM, Kooi ME. Imaging Intraplaque Inflammation in Carotid Atherosclerosis With 18F-Fluorocholine Positron Emission Tomography-Computed Tomography: Prospective Study on Vulnerable Atheroma With Immunohistochemical Validation. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004467. [PMID: 27162131 DOI: 10.1161/circimaging.115.004467] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/17/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND (18)F-fluorocholine ((18)F-FCH) uptake is associated with cell proliferation and activity in tumor patients. We hypothesized that (18)F-FCH could similarly be a valuable imaging tool to identify vulnerable plaques and associated intraplaque inflammation and atheroma cell proliferation. METHODS AND RESULTS Ten consecutive stroke patients (90% men, median age 66.5 years, range, 59.4-69.7) with ipsilateral >70% carotid artery stenosis and who underwent carotid endarterectomy were included in the study. Before carotid endarterectomy, all patients underwent positron emission tomography to assess maximum (18)F-FCH uptake in ipsilateral symptomatic carotid plaques and contralateral asymptomatic carotid arteries, which was corrected for background activity, resulting in a maximum target-to-background ratio (TBRmax). Macrophage content was assessed in all carotid endarterectomy specimens as a percentage of CD68(+)-staining per whole plaque area (plaqueCD68(+)) and as a maximum CD68(+) percentage (maxCD68(+)) in the most inflamed section/plaque. Dynamic positron emission tomography imaging demonstrated that an interval of 10 minutes between (18)F-FCH injection and positron emission tomography acquisition is appropriate for carotid plaque imaging. TBRmax in ipsilateral symptomatic carotid plaques correlated significantly with plaqueCD68(+) (Spearman's ρ=0.648, P=0.043) and maxCD68(+) (ρ=0.721, P=0.019) in the 10 corresponding carotid endarterectomy specimens. TBRmax was significantly higher (P=0.047) in ipsilateral symptomatic carotid plaques (median: 2.0; interquartile range [Q1-Q3], 1.5-2.5) compared with the contralateral asymptomatic carotid arteries (median: 1.4; Q1-Q3, 1.3-1.6). TBRmax was not significantly correlated to carotid artery stenosis (ρ=0.506, P=0.135). CONCLUSIONS In vivo uptake of (18)F-FCH in human carotid atherosclerotic plaques correlated strongly with degree of macrophage infiltration and recent symptoms, thus (18)F-FCH positron emission tomography is a promising tool for the evaluation of vulnerable plaques. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01899014.
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Affiliation(s)
- Stefan Vöö
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Robert M Kwee
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Judith C Sluimer
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Floris H B M Schreuder
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Roel Wierts
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Matthias Bauwens
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Sylvia Heeneman
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Jack P M Cleutjens
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Robert J van Oostenbrugge
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Jan-Willem H Daemen
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Mat J A P Daemen
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Felix M Mottaghy
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.).
| | - M Eline Kooi
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.).
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Krishnan S, Otaki Y, Doris M, Slipczuk L, Arnson Y, Rubeaux M, Dey D, Slomka P, Berman DS, Tamarappoo B. Molecular Imaging of Vulnerable Coronary Plaque: A Pathophysiologic Perspective. J Nucl Med 2017; 58:359-364. [DOI: 10.2967/jnumed.116.187906] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/25/2017] [Indexed: 12/13/2022] Open
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Joseph P, Tawakol A. Imaging atherosclerosis with positron emission tomography. Eur Heart J 2016; 37:2974-2980. [PMID: 27125951 DOI: 10.1093/eurheartj/ehw147] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/10/2016] [Accepted: 03/16/2016] [Indexed: 02/01/2023] Open
Abstract
Positron emission tomography (PET) provides a non-invasive method to measure biological processes that are relevant to atherosclerosis, including arterial inflammation and calcification. The vast majority of studies imaging atherosclerosis with PET have utilized the tracer 18F-fluorodeoxyglucose (FDG) to better understand how inflammation contributes to atherosclerosis development, and to test the efficacy of therapeutic interventions aimed at reducing its progression. Additional tracers such as 18F-sodium fluoride (18F-NaF) provide additional avenues for characterizing atherosclerosis development. This review examines the emerging uses of PET arterial imaging as a marker of vascular inflammation and atherosclerosis, as a prognostic tool, and as a clinical research tool. In addition, we examine emerging methods that should advance arterial imaging with PET.
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Affiliation(s)
- Philip Joseph
- Cardiac MR PET CT Program, and Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Suite 400, 165 Cambridge St., Boston, MA, USA.,Population Health Research Institute, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Ahmed Tawakol
- Cardiac MR PET CT Program, and Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Suite 400, 165 Cambridge St., Boston, MA, USA
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29
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Forsythe RO, Newby DE, Robson JMJ. Monitoring the biological activity of abdominal aortic aneurysms Beyond Ultrasound. Heart 2016; 102:817-24. [PMID: 26879242 PMCID: PMC4893091 DOI: 10.1136/heartjnl-2015-308779] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/21/2016] [Indexed: 12/27/2022] Open
Abstract
Abdominal aortic aneurysms (AAAs) are an important cause of morbidity and, when ruptured, are associated with >80% mortality. Current management decisions are based on assessment of aneurysm diameter by abdominal ultrasound. However, AAA growth is non-linear and rupture can occur at small diameters or may never occur in those with large AAAs. There is a need to develop better imaging biomarkers that can identify the potential risk of rupture independent of the aneurysm diameter. Key pathobiological processes of AAA progression and rupture include neovascularisation, necrotic inflammation, microcalcification and proteolytic degradation of the extracellular matrix. These processes represent key targets for emerging imaging techniques and may confer an increased risk of expansion or rupture over and above the known patient-related risk factors. Magnetic resonance imaging, using ultrasmall superparamagnetic particles of iron oxide, can identify and track hotspots of macrophage activity. Positron emission tomography, using a variety of targeted tracers, can detect areas of inflammation, angiogenesis, hypoxia and microcalcification. By going beyond the simple monitoring of diameter expansion using ultrasound, these cellular and molecular imaging techniques may have the potential to allow improved prediction of expansion or rupture and to better guide elective surgical intervention.
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Affiliation(s)
- Rachael O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jennifer M J Robson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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30
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Hellberg S, Silvola JMU, Kiugel M, Liljenbäck H, Metsälä O, Viljanen T, Metso J, Jauhiainen M, Saukko P, Nuutila P, Ylä-Herttuala S, Knuuti J, Roivainen A, Saraste A. Type 2 diabetes enhances arterial uptake of choline in atherosclerotic mice: an imaging study with positron emission tomography tracer ¹⁸F-fluoromethylcholine. Cardiovasc Diabetol 2016; 15:26. [PMID: 26852231 PMCID: PMC4744438 DOI: 10.1186/s12933-016-0340-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/18/2016] [Indexed: 01/13/2023] Open
Abstract
Background Diabetes is a risk factor for atherosclerosis associated with oxidative stress, inflammation and cell proliferation. The purpose of this study was to evaluate arterial choline uptake and its relationship to atherosclerotic inflammation in diabetic and non-diabetic hypercholesterolemic mice. Methods Low-density lipoprotein-receptor deficient mice expressing only apolipoprotein B100, with or without type 2 diabetes caused by pancreatic overexpression of insulin-like growth factor II (IGF-II/LDLR−/−ApoB100/100 and LDLR−/−ApoB100/100) were studied. Distribution kinetics of choline analogue 18F-fluoromethylcholine (18F-FMCH) was assessed in vivo by positron emission tomography (PET) imaging. Then, aortic uptakes of 18F-FMCH and glucose analogue 18F-fluorodeoxyglucose (18F-FDG), were assessed ex vivo by gamma counting and autoradiography of tissue sections. The 18F-FMCH uptake in atherosclerotic plaques was further compared with macrophage infiltration and the plasma levels of cytokines and metabolic markers. Results The aortas of all hypercholesterolemic mice showed large, macrophage-rich atherosclerotic plaques. The plaque burden and densities of macrophage subtypes were similar in diabetic and non-diabetic animals. The blood clearance of 18F-FMCH was rapid. Both the absolute 18F-FMCH uptake in the aorta and the aorta-to-blood uptake ratio were higher in diabetic than in non-diabetic mice. In autoradiography, the highest 18F-FMCH uptake co-localized with macrophage-rich atherosclerotic plaques. 18F-FMCH uptake in plaques correlated with levels of total cholesterol, insulin, C-peptide and leptin. In comparison with 18F-FDG, 18F-FMCH provided similar or higher plaque-to-background ratios in diabetic mice. Conclusions Type 2 diabetes enhances the uptake of choline that reflects inflammation in atherosclerotic plaques in mice. PET tracer 18F-FMCH is a potential tool to study vascular inflammation associated with diabetes. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0340-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sanna Hellberg
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Johanna M U Silvola
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Max Kiugel
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Heidi Liljenbäck
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland. .,Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland.
| | - Olli Metsälä
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Tapio Viljanen
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Jari Metso
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Haartmaninkatu 8, 00250, Helsinki, Finland.
| | - Matti Jauhiainen
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Haartmaninkatu 8, 00250, Helsinki, Finland.
| | - Pekka Saukko
- Department of Pathology and Forensic Medicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland.
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland. .,Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70210, Kuopio, Finland. .,Science Service Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland. .,Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Anne Roivainen
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland. .,Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland. .,Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Antti Saraste
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland. .,Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland. .,Heart Center, Turku University Hospital, Hämeentie 11, 20520, Turku, Finland.
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Position paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM) on PET imaging of atherosclerosis. Eur J Nucl Med Mol Imaging 2015; 43:780-92. [PMID: 26678270 PMCID: PMC4764627 DOI: 10.1007/s00259-015-3259-3] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 01/15/2023]
Abstract
Cardiovascular diseases are the leading cause of death not only in Europe but also in the rest of the World. Preventive measures, however, often fail and cardiovascular disease may manifest as an acute coronary syndrome, stroke or even sudden death after years of silent progression. Thus, there is a considerable need for innovative diagnostic and therapeutic approaches to improve the quality of care and limit the burden of cardiovascular diseases. During the past 10 years, several retrospective and prospective clinical studies have been published using 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) to quantify inflammation in atherosclerotic plaques. However, the current variety of imaging protocols used for vascular (arterial) imaging with FDG PET considerably limits the ability to compare results between studies and to build large multicentre imaging registries. Based on the existing literature and the experience of the Members of the European Association of Nuclear Medicine (EANM) Cardiovascular Committee, the objective of this position paper was to propose optimized and standardized protocols for imaging and interpretation of PET scans in atherosclerosis. These recommendations do not, however, replace the individual responsibility of healthcare professionals to make appropriate decisions in the circumstances of the individual study protocols used and the individual patient, in consultation with the patient and, where appropriate and necessary, the patient’s guardian or carer. These recommendations suffer from the absence of conclusive evidence on many of the recommendations. Therefore, they are not intended and should not be used as "strict guidelines" but should, as already mentioned, provide a basis for standardized clinical atherosclerosis PET imaging protocols, which are subject to further and continuing evaluation and improvement. However, this EANM position paper might indeed be a first step towards "official" guidelines on atherosclerosis imaging with PET.
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Lee SJ, Paeng JC. Nuclear Molecular Imaging for Vulnerable Atherosclerotic Plaques. Korean J Radiol 2015; 16:955-66. [PMID: 26357491 PMCID: PMC4559792 DOI: 10.3348/kjr.2015.16.5.955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/12/2015] [Indexed: 01/09/2023] Open
Abstract
Atherosclerosis is an inflammatory disease as well as a lipid disorder. Atherosclerotic plaque formed in vessel walls may cause ischemia, and the rupture of vulnerable plaque may result in fatal events, like myocardial infarction or stroke. Because morphological imaging has limitations in diagnosing vulnerable plaque, molecular imaging has been developed, in particular, the use of nuclear imaging probes. Molecular imaging targets various aspects of vulnerable plaque, such as inflammatory cell accumulation, endothelial activation, proteolysis, neoangiogenesis, hypoxia, apoptosis, and calcification. Many preclinical and clinical studies have been conducted with various imaging probes and some of them have exhibited promising results. Despite some limitations in imaging technology, molecular imaging is expected to be used both in the research and clinical fields as imaging instruments become more advanced.
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Affiliation(s)
- Soo Jin Lee
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul 03080, Korea. ; Department of Nuclear Medicine, National Cancer Center, Goyang 10408, Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul 03080, Korea
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Alie N, Eldib M, Fayad ZA, Mani V. Inflammation, Atherosclerosis, and Coronary Artery Disease: PET/CT for the Evaluation of Atherosclerosis and Inflammation. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:13-21. [PMID: 25674025 PMCID: PMC4294600 DOI: 10.4137/cmc.s17063] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/16/2014] [Accepted: 11/20/2014] [Indexed: 12/16/2022]
Abstract
Atherosclerosis is a prevalent cardiovascular disease marked by inflammation and the formation of plaque within arterial walls. As the disease progresses, there is an increased risk of major cardiovascular events. Owing to the nature of atherosclerosis, it is imperative to develop methods to further understand the physiological implications and progression of the disease. The combination of positron emission tomography (PET)/computed tomography (CT) has proven to be promising for the evaluation of atherosclerotic plaques and inflammation within the vessel walls. The utilization of the radiopharmaceutical tracer, 18F-fluorodeoxyglucose (18F-FDG), with PET/CT is invaluable in understanding the pathophysiological state involved in atherosclerosis. In this review, we will discuss the use of 18F-FDG-PET/CT imaging for the evaluation of atherosclerosis and inflammation both in preclinical and clinical studies. The potential of more specific novel tracers will be discussed. Finally, we will touch on the potential benefits of using the newly introduced combined PET/magnetic resonance imaging (MRI) for non-invasive imaging of atherosclerosis.
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Affiliation(s)
- Nadia Alie
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mootaz Eldib
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Venkatesh Mani
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Tarkin JM, Joshi FR, Rajani NK, Rudd JHF. PET imaging of atherosclerosis. Future Cardiol 2015; 11:115-31. [DOI: 10.2217/fca.14.55] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
ABSTRACT Atherosclerosis is a chronic, progressive, multifocal disease of the arterial wall, which is mainly fuelled by local and systemic inflammation, often resulting in acute ischemic events following plaque rupture and vessel occlusion. When assessing the cardiovascular risk of an individual patient, we must consider both global measures of disease activity and local features of plaque vulnerability, in addition to anatomical distribution and degree of established atherosclerosis. These parameters cannot be measured with conventional anatomical imaging techniques alone, which are designed primarily to identify the presence of organic intraluminal obstruction in symptomatic patients. However, molecular imaging with PET, using specifically targeted radiolabeled probes to track active in vivo atherosclerotic mechanisms noninvasively, may potentially provide a method that is better suited for this purpose. Vascular PET imaging can help us to further understand aspects of plaque biology, and current evidence supports a future role as an emerging clinical tool for the quantification of cardiovascular risk in order to guide and monitor responses to antiatherosclerosis treatments and to distinguish high-risk plaques.
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Affiliation(s)
- Jason M Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Box 110, Addenbrooke's Centre for Clinical Investigation, Hills Road, Cambridge CB2 2QQ, UK
| | - Francis R Joshi
- Division of Cardiovascular Medicine, University of Cambridge, Box 110, Addenbrooke's Centre for Clinical Investigation, Hills Road, Cambridge CB2 2QQ, UK
| | - Nikil K Rajani
- Division of Cardiovascular Medicine, University of Cambridge, Box 110, Addenbrooke's Centre for Clinical Investigation, Hills Road, Cambridge CB2 2QQ, UK
| | - James HF Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Box 110, Addenbrooke's Centre for Clinical Investigation, Hills Road, Cambridge CB2 2QQ, UK
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Rosa GM, Bauckneht M, Masoero G, Mach F, Quercioli A, Seitun S, Balbi M, Brunelli C, Parodi A, Nencioni A, Vuilleumier N, Montecucco F. The vulnerable coronary plaque: update on imaging technologies. Thromb Haemost 2013; 110:706-22. [PMID: 23803753 DOI: 10.1160/th13-02-0121] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/01/2013] [Indexed: 12/21/2022]
Abstract
Several studies have been carried out on vulnerable plaque as the main culprit for ischaemic cardiac events. Historically, the most important diagnostic technique for studying coronary atherosclerotic disease was to determine the residual luminal diameter by angiographic measurement of the stenosis. However, it has become clear that vulnerable plaque rupture as well as thrombosis, rather than stenosis, triggers most acute ischaemic events and that the quantification of risk based merely on severity of the arterial stenosis is not sufficient. In the last decades, substantial progresses have been made on optimisation of techniques detecting the arterial wall morphology, plaque composition and inflammation. To date, the use of a single technique is not recommended to precisely identify the progression of the atherosclerotic process in human beings. In contrast, the integration of data that can be derived from multiple methods might improve our knowledge about plaque destabilisation. The aim of this narrative review is to update evidence on the accuracy of the currently available non-invasive and invasive imaging techniques in identifying components and morphologic characteristics associated with coronary plaque vulnerability.
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Affiliation(s)
- Gian Marco Rosa
- Fabrizio Montecucco, MD, PhD, Division of Cardiology, Faculty of Medicine, Geneva University Hospital, Avenue de la Roseraie 64, 1211 Geneva 4, Switzerland, Tel.: +41 22 372 71 92, Fax: +41 22 382 72 45, E-mail:
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Wu C, Li F, Niu G, Chen X. PET imaging of inflammation biomarkers. Theranostics 2013; 3:448-66. [PMID: 23843893 PMCID: PMC3706689 DOI: 10.7150/thno.6592] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 05/24/2013] [Indexed: 01/04/2023] Open
Abstract
Inflammation plays a significant role in many disease processes. Development in molecular imaging in recent years provides new insight into the diagnosis and treatment evaluation of various inflammatory diseases and diseases involving inflammatory process. Positron emission tomography using (18)F-FDG has been successfully applied in clinical oncology and neurology and in the inflammation realm. In addition to glucose metabolism, a variety of targets for inflammation imaging are being discovered and utilized, some of which are considered superior to FDG for imaging inflammation. This review summarizes the potential inflammation imaging targets and corresponding PET tracers, and the applications of PET in major inflammatory diseases and tumor associated inflammation. Also, the current attempt in differentiating inflammation from tumor using PET is also discussed.
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Sarda-Mantel L, Alsac JM, Boisgard R, Hervatin F, Montravers F, Tavitian B, Michel JB, Le Guludec D. Comparison of 18F-fluoro-deoxy-glucose, 18F-fluoro-methyl-choline, and 18F-DPA714 for positron-emission tomography imaging of leukocyte accumulation in the aortic wall of experimental abdominal aneurysms. J Vasc Surg 2012; 56:765-73. [PMID: 22726755 DOI: 10.1016/j.jvs.2012.01.069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/20/2012] [Accepted: 01/29/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) is a frequent form of atherothrombotic disease, whose natural history is to enlarge and rupture. Indicators other than AAA diameter would be useful for preventive surgery decision-making, including positron-emission tomography (PET) methods permitting visualization of aortic wall leukocyte activation relevant to prognostic AAA evaluation. In this study, we compare three PET tracers of activated leukocytes, 18F-fluoro-deoxy-glucose (FDG), 18F-fluoro-methyl-choline (FCH), and 18F-DPA714 (a peripheral benzodiazepine receptor antagonist) for in vivo PET quantification of aortic wall inflammation in rat experimental AAAs, in correlation with histopathological studies of lesions. METHODS AAAs were induced by orthotopic implantation of decellularized guinea pig abdominal aorta in 46 Lewis rats. FDG-PET (n = 20), FCH-PET (n = 8), or both (n = 12) were performed 2 weeks to 4 months after the graft, 1 hour after tracer injection (30 MBq). Six rats (one of which had FDG-PET) underwent 18F-DPA714-PET. Rats were sacrificed after imaging; AAAs and normal thoracic aortas were cut into axial sections for quantitative autoradiography and histologic studies, including ED1 (macrophages) and CD8 T lymphocyte immunostaining. Ex vivo staining of AAAs and thoracic aortas with 18F-DPA714 and unlabeled competitors was performed. RESULTS AAAs developed in 35 out of 46 cases. FCH uptake in AAAs was lower than that of FDG in all cases on imaging, with lower AAA-to-background maximal standardized uptake value (SUV(max)) ratios (1.78 ± 0.40 vs 2.71 ± 0.54; P < .01 for SUV(max) ratios), and lower AAA-to-normal aorta activity ratios on autoradiography (3.52 ± 1.26 vs 8.55 ± 4.23; P < .005). FDG AAA-to-background SUV(max) ratios correlated with the intensity of CD8 + ED1 staining (r = .76; P < .03). FCH AAA-to-background SUV(max) ratios correlated with the intensity of ED1 staining (r = .80; P < .03). 18F-DPA714 uptake was similar in AAAs and in normal aortas, both in vivo and ex vivo. CONCLUSIONS In rat experimental AAA, characterized by an important aortic wall leukocytes activity, FDG-PET showed higher sensitivity than FCH-PET and 18F-DPA714-PET to detect activated leukocytes. This enhances potential interest of this tracer for prognostic evaluation of AAA in patients.
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Affiliation(s)
- Laure Sarda-Mantel
- Institut National de la Santé et de la Recherche Médicale Unit 698, Paris, France.
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Diabetes and Vascular 18F-Fluorodeoxyglucose Positron Emission Tomography Uptake. J Am Coll Cardiol 2012; 59:2089-90. [DOI: 10.1016/j.jacc.2012.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/14/2012] [Indexed: 11/17/2022]
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Joshi FR, Lindsay AC, Obaid DR, Falk E, Rudd JHF. Non-invasive imaging of atherosclerosis. Eur Heart J Cardiovasc Imaging 2012; 13:205-18. [PMID: 22277118 DOI: 10.1093/ehjci/jer319] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Atherosclerosis is an inflammatory disease that causes most myocardial infarctions, strokes, and acute coronary syndromes. Despite the identification of multiple risk factors and widespread use of drug therapies, it still remains a global health concern with associated costs. It is well known that the risks of atherosclerotic plaque rupture are not well correlated with stenosis severity. Lumenography has a central place for defining the site and severity of vascular stenosis as a prelude to intervention for relief of symptoms due to blood flow limitation. Atherosclerosis develops within the arterial wall; this is not imaged by lumenography and hence it provides no information regarding underlying processes that may lead to plaque rupture. For this, we must rely on other imaging modalities such as ultrasound, computed tomography, magnetic resonance imaging, and nuclear imaging methods. These are capable of reporting on the underlying pathology, in particular the presence of inflammation, calcification, neovascularization, and intraplaque haemorrhage. Additionally, non-invasive imaging can now be used to track the effect of anti-atherosclerosis therapy. Each modality alone has positives and negatives and this review will highlight these, as well as speculating on future developments in this area.
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Affiliation(s)
- Francis R Joshi
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, UK.
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Derlin T, Tóth Z, Papp L, Wisotzki C, Apostolova I, Habermann CR, Mester J, Klutmann S. Correlation of Inflammation Assessed by 18F-FDG PET, Active Mineral Deposition Assessed by 18F-Fluoride PET, and Vascular Calcification in Atherosclerotic Plaque: A Dual-Tracer PET/CT Study. J Nucl Med 2011; 52:1020-7. [DOI: 10.2967/jnumed.111.087452] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Derlin T, Wisotzki C, Richter U, Apostolova I, Bannas P, Weber C, Mester J, Klutmann S. In vivo imaging of mineral deposition in carotid plaque using 18F-sodium fluoride PET/CT: correlation with atherogenic risk factors. J Nucl Med 2011; 52:362-8. [PMID: 21321276 DOI: 10.2967/jnumed.110.081208] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED The purpose of this study was to correlate (18)F-sodium fluoride accumulation in the common carotid arteries of neurologically asymptomatic patients with cardiovascular risk factors and carotid calcified plaque burden. METHODS Two hundred sixty-nine oncologic patients were examined by (18)F-sodium fluoride PET/CT. Tracer accumulation in the common carotid arteries was analyzed both qualitatively and semiquantitatively by measuring the blood-pool-corrected standardized uptake value (target-to-background ratio) and comparing it with cardiovascular risk factors and calcified plaque burden. RESULTS (18)F-sodium fluoride uptake was observed at 141 sites in 94 (34.9%) patients. Radiotracer accumulation was colocalized with calcification in all atherosclerotic lesions. (18)F-sodium fluoride uptake was significantly associated with age (P < 0.0001), male sex (P < 0.0001), hypertension (P < 0.002), and hypercholesterolemia (P < 0.05). The presence of calcified plaque correlated significantly with these risk factors but also with diabetes (P < 0.0001), history of smoking (P = 0.03), and prior cardiovascular events (P < 0.01). There was a highly significant correlation between the presence of (18)F-sodium fluoride uptake and number of present cardiovascular risk factors (r = 0.30, P < 0.0001). CONCLUSION Carotid (18)F-sodium fluoride uptake is a surrogate measure of calcifying carotid plaque, correlates with cardiovascular risk factors, and is more frequent in patients with a high-risk profile for atherothrombotic events but demonstrates a weaker correlation with risk factors than does calcified plaque burden. This study provides a rationale to conduct further prospective studies to determine whether (18)F-sodium fluoride uptake can predict vascular events, or if it may be used to monitor pharmacologic therapy.
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Affiliation(s)
- Thorsten Derlin
- Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Abstract
It is now well recognized that the atherosclerotic plaques responsible for thrombus formation are not necessarily those that impinge most on the lumen of the vessel. Nevertheless, clinical investigations for atherosclerosis still focus on quantifying the degree of stenosis caused by plaques. Many of the features associated with a high-risk plaque, including a thin fibrous cap, large necrotic core, macrophage infiltration, neovascularization, and intraplaque hemorrhage, can now be probed by novel imaging techniques. Each technique has its own strengths and drawbacks. In this article, we review the various imaging modalities used for the evaluation and quantification of atherosclerosis.
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Affiliation(s)
- D.R.J. Owen
- Department of Experimental Medicine and Toxicology, Imperial College London, Hammersmith Hospital, London W12 0NN, United Kingdom;
- Clinical Imaging Center, GlaxoSmithKline, London W12 0NN, United Kingdom
| | - A.C. Lindsay
- Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - R.P. Choudhury
- Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Z.A. Fayad
- Imaging Science Laboratories, Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, New York 10029;
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Novel approach to improve molecular imaging research: correlation between macroscopic and molecular pathological findings in patients. Eur J Radiol 2010; 79:365-8. [PMID: 20863640 DOI: 10.1016/j.ejrad.2010.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 08/24/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE Currently, clinical research approaches are sparse in molecular imaging studies. Moreover, possible links between imaging features and pathological laboratory parameters are unknown, so far. Therefore, the goal was to find a possible relationship between imaging features and peripheral blood cell apoptosis, and thereby to present a novel way to complement molecular imaging research. MATERIALS AND METHODS The investigation has been done in systemic lupus erythematosus (SLE), a prototype of an autoimmune disease characterized by multiorgan involvement, autoantibody production, and disturbed apoptosis. Retrospectively, radiological findings have been compared to both autoantibody findings and percentage apoptotic blood cells. RESULTS Two SLE groups could be identified: patients with normal (annexin V binding<20%), and with increased apoptosis (annexin V binding>20%) of peripheral blood cells. The frequency of radiological examinations in SLE patients significantly correlated with an increased percentage of apoptotic cells (p<0.005). In patients with characteristic imaging findings (e.g. lymph node swelling, pleural effusion) an elevated percentage of apoptotic cells was present. In contrast SLE-patients with normal imaging findings or uncharacteristic results of minimal severity had normal percentages of apoptotic blood cells. CONCLUSION This correlation between radiographic findings and percentage of apoptotic blood cells provides (1) further insight into pathological mechanisms of SLE, (2) will offer the possibility to introduce apoptotic biomarkers as molecular probes for clinical molecular imaging approaches in future to early diagnose organ complaints in patients with SLE, and (3) is a plea to complement molecular imaging research by this clinical approach.
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Danne O, Möckel M. Choline in acute coronary syndrome: an emerging biomarker with implications for the integrated assessment of plaque vulnerability. Expert Rev Mol Diagn 2010; 10:159-71. [PMID: 20214535 DOI: 10.1586/erm.10.2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Whole-blood choline, plasma choline and serum choline are emerging biomarkers in acute coronary syndrome related to coronary plaque instability with platelet thrombus formation and ischemia. Whole-blood choline is an early predictor for cardiac events, which adds to troponins, natriuretic peptides and inflammatory markers. Serum choline is highly predictive for myocardial infarction and discriminates high- from low-risk subgroups in troponin-positive patients. Choline is a candidate marker to aid decision making in the emergency room in the upcoming era of sensitive troponin tests and the growing need to differentiate between ischemic and nonischemic etiologies of troponin elevations. The integrated approach of in vitro choline measurement in combination with advanced techniques of in vivo choline imaging represents a novel future strategy for detecting vulnerable plaques. This paper provides an up-to-date review of choline in acute coronary syndrome including key aspects of pathophysiology, analytical methods, clinical studies and implications for the integrated assessment of plaque vulnerability.
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Affiliation(s)
- Oliver Danne
- Department of Medicine, Internal Intensive Care and Nephrology, Charité - Universitätsmedizin Berlin/Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Derlin T, Richter U, Bannas P, Begemann P, Buchert R, Mester J, Klutmann S. Feasibility of 18F-sodium fluoride PET/CT for imaging of atherosclerotic plaque. J Nucl Med 2010; 51:862-5. [PMID: 20484438 DOI: 10.2967/jnumed.110.076471] [Citation(s) in RCA: 199] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The aim of this study was to examine the prevalence, distribution, and topographic relationship of vascular (18)F-sodium fluoride uptake and arterial calcification in major arteries. METHODS Image data obtained from 75 patients undergoing whole-body (18)F-sodium fluoride PET/CT were evaluated retrospectively. Arterial radiotracer uptake and calcification were analyzed qualitatively and semiquantitatively. RESULTS (18)F-sodium fluoride uptake was observed at 254 sites in 57 (76%) of the 75 study patients, and calcification was observed at 1,930 sites in 63 (84%) of the patients. Colocalization of radiotracer accumulation and calcification could be observed in 223 areas of uptake (88%). However, only 12% of all arterial calcification sites showed increased radiotracer uptake. CONCLUSION Our data indicate the feasibility of (18)F-sodium fluoride PET/CT for the imaging of mineral deposition in arterial wall alterations. (18)F-sodium fluoride PET/CT may provide relevant information about the morphologic and functional properties of calcified plaque.
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Affiliation(s)
- Thorsten Derlin
- Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Laitinen IEK, Luoto P, Någren K, Marjamäki PM, Silvola JMU, Hellberg S, Laine VJO, Ylä-Herttuala S, Knuuti J, Roivainen A. Uptake of 11C-choline in mouse atherosclerotic plaques. J Nucl Med 2010; 51:798-802. [PMID: 20395326 DOI: 10.2967/jnumed.109.071704] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The purpose of this study was to explore the feasibility of (11)C-choline in the assessment of the degree of inflammation in atherosclerotic plaques. METHODS Uptake of (11)C-choline was studied ex vivo in tissue samples and aortic sections excised from 6 atherosclerotic mice deficient for both low-density lipoprotein receptor and apolipoprotein B48 (LDLR(-/-)ApoB(100/100)) and 5 control mice. The autoradiographs were compared with the immunohistology of the arterial sites. RESULTS The uptake of (11)C-choline (percentage of the injected activity per gram of tissue) in the atherosclerotic aortas of the LDLR(-/-)ApoB(100/100) mice was significantly higher (1.9-fold, P = 0.0016) than that in the aortas of the control mice. The autoradiography analysis showed significantly higher uptake of (11)C-choline in the plaques than in healthy vessel wall (mean ratio, 2.3 +/- 0.6; P = 0.014), prominently in inflamed plaques, compared with noninflamed plaque areas. CONCLUSION We observed a high (11)C-choline uptake in the aortic plaques of atherosclerotic mice. Our data suggest that macrophages may be responsible for the uptake of (11)C-choline in the plaques.
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Imaging of vulnerable plaque: Potential breakthrough or pipe dream? CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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