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Shi X, Tao T, Wang Y, Han Y, Xu X, Yin Q, Wang F, Liu R, Liu X. Heavy macrophage infiltration identified by optical coherence tomography relates to plaque rupture. Ann Clin Transl Neurol 2023; 10:2334-2346. [PMID: 37822283 PMCID: PMC10723231 DOI: 10.1002/acn3.51923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE Risk stratification plays a critical role in patients with asymptomatic carotid atherosclerotic stenosis. Heavy macrophage infiltration (HMC) is an important factor of plaque destabilization. However, in vivo imaging technologies and screening criteria for HMC remain limited. We aimed to (i) introduce algorithms for in vivo detection of macrophage infiltrations using optical coherence tomography (OCT) and (ii) to investigate the threshold of HMC and its association with plaque vulnerability. METHODS Ex vivo OCT images were co-registered with histopathology in 282 cross-sectional pairs from 19 carotid endarterectomy specimens. Of these, 197 randomly selected pairs were employed to define the parameters, and the remaining 85 pairs were used to evaluate the accuracy of the OCT-based algorithm in detecting macrophage infiltrations. Clinical analysis included 93 patients receiving carotid OCT evaluation. The prevalence and burden of macrophage infiltration were analyzed. Multivariable and subgroup analysis were performed to investigate the association between HMC and plaque rupture. RESULTS The sensitivity and specificity of algorithm for detecting macrophage infiltration were 88.0% and 74.9%, respectively. Of 93 clinical patients, ruptured plaques exhibited higher prevalence of macrophage infiltration than nonruptured plaques (83.7% [36/43] vs 32.0% [16/50], p < 0.001). HMC was identified when the macrophage index was greater than 60.2 (sensitivity = 74.4%, specificity = 84.0%). Multivariable analysis showed that HMC and multiple calcification were independent risk factors for non-lipid-rich plaque rupture. INTERPRETATION This study provides a novel approach and screening criteria for HMC, which might be valuable for atherosclerotic risk stratification.
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Affiliation(s)
- Xuan Shi
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Tao Tao
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Yi Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Yunfei Han
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xiaohui Xu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Qin Yin
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Fang Wang
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Rui Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xinfeng Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
- Stroke Center and Department of Neurology, First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
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Cohen O, Kaufman AE, Choi H, Khan S, Robson PM, Suárez-Fariñas M, Mani V, Shah NA. Pharyngeal Inflammation on Positron Emission Tomography/Magnetic Resonance Imaging Before and After Obstructive Sleep Apnea Treatment. Ann Am Thorac Soc 2023; 20:574-583. [PMID: 36476449 PMCID: PMC10112411 DOI: 10.1513/annalsats.202207-594oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/07/2022] [Indexed: 12/12/2022] Open
Abstract
Rationale: There is upper airway inflammation in patients with obstructive sleep apnea (OSA), which reduces with continuous positive airway pressure (CPAP) therapy. Objectives: Validate the use of positron emission tomography (PET)/magnetic resonance imaging (MRI) to quantify metabolic activity within the pharyngeal mucosa of patients with OSA against nasal lavage proteomics and assess the impact of CPAP therapy. Methods: Adults with OSA underwent [18F]-Fluoro-2-deoxy-D-glucose PET/MRI of the neck before and 3 months after initiating CPAP. Nasal lavage samples were collected. Inflammatory protein expression from samples was analyzed using the Olink platform. Upper airway imaging segmentation was performed. Target-to-background ratio (TBRmax) was calculated from target pharyngeal maximum standard uptake values (SUV) and personalized background mean SUV. Most-diseased segment TBRmax was identified per participant at locations with the highest PET avidity. Correlation analysis was performed between baseline TBRmax and nasal lavage proteomics. TBRmax was compared before and after CPAP using linear mixed-effect models. Results: Among 38 participants, the baseline mean age was 46.3 years (standard deviation [SD], 12.5), 21% were female, the mean body mass index was 30.9 kg/m2 (SD, 4.6), and the mean respiratory disturbance index measured by peripheral arterial tonometry was 31 events/h (SD, 16.4). There was a significant positive correlation between pharyngeal mucosa most-diseased segment TBRmax and nasal lavage proteomic inflammation (r = 0.41 [P < 0.001, false discovery rate = 0.002]). Primary analysis revealed a reduction in the most-diseased segment TBRmax after a median of 2.91 months of CPAP therapy (-0.86 [standard error (SE) ± 0.30; P = 0.007]). Stratified analysis by smoking status revealed a significantly decreased most-diseased segment TBRmax after CPAP therapy among never-smokers but not among ever-smokers (-1.01 [SE ± 0.39; P = 0.015] vs. -0.64 [SE ± 0.49; P = 0.201]). Conclusions: CPAP therapy reduces metabolic activity measured by PET/MRI within the upper airway of adults with OSA. Furthermore, PET/MRI measures of upper airway metabolic activity correlate with a noninvasive marker of inflammation (i.e., nasal lavage inflammatory protein expression).
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Affiliation(s)
- Oren Cohen
- Division of Pulmonary, Critical Care, and Sleep Medicine
| | | | - Hyewon Choi
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samira Khan
- Division of Pulmonary, Critical Care, and Sleep Medicine
| | | | - Mayte Suárez-Fariñas
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Neomi A. Shah
- Division of Pulmonary, Critical Care, and Sleep Medicine
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Kirienko M, Erba PA, Chiti A, Sollini M. Hybrid PET/MRI in Infection and Inflammation: An Update About the Latest Available Literature Evidence. Semin Nucl Med 2023; 53:107-124. [PMID: 36369091 DOI: 10.1053/j.semnuclmed.2022.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/13/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022]
Abstract
PET/MRI has been reported to be promising in the diagnosis and evaluation of infection and inflammation including brain disorders, bone and soft tissue infections and inflammations, cardiovascular, abdominal, and systemic diseases. However, evidence came out manly from anecdotal cases or small cohorts. The present review aimed to update the latest available evidence about the role of PET/MRI in infection and inflammation. The search (January, 1 2018-July, 8 2022) on PubMed produced 504 results. Sixty-five articles were selected and included in the qualitative synthesis. The number of publications on PET/MRI in the 3 years 2018-2020 was comparable, while it increased in 2021 and 2022 (from 11 to 17 and 15, respectively). [18F]FDG and 68Ga-DOTA-FAPI-04 were the most frequently used (42/65) and innovative radiopharmaceuticals, respectively. [18F]fluoride (9/65), translocator protein (TSPO)-targeted PET agents (6/65), CXCR4 receptor targeting tracer and β-amyloid plaques binding radiopharmaceuticals (2/65 and 2/65, respectively) were also used. Most PET/MRI studies in the period 2018-2022 focused on inflammation (55/65), and cardiovascular diseases represented the most frequent field of interest (30/65), also when considering each year singularly. An increasing trend in bone and joint publications was observed in the considered period (12/65). Other topics included neurology (11/65), inflammatory bowel disease (8/65), and other (4/65). PET/MRI technology demonstrated to be useful in infection and inflammation, being superior to each single modality and/or facilitating diagnosis in a number of conditions (eg, cardiac sarcoidosis, myocarditis, endocarditis), and/or allowing to provide insightful information about disease biology and apply innovative radiopharmaceuticals (eg, neurology, atherosclerosis). Publications focused on PET/MRI in large vessel vasculitis and aortic diseases include both diagnostic and discovery objectives. The current review corroborates the potential of PET/MRI - combining in a single examination the high soft tissue contrast, high resolution, and functional information of MRI, with molecular data provided by PET technology - to positively impact on the management of infectious diseases and inflammatory conditions.
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Affiliation(s)
| | - Paola A Erba
- Nuclear Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy.
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy
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4
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Tanaka A, Sekine T, Ter Voert EEGW, Zeimpekis KG, Delso G, de Galiza Barbosa F, Warnock G, Kumita SI, Veit Haibach P, Huellner M. Reproducibility of Standardized Uptake Values Including Volume Metrics Between TOF-PET-MR and TOF-PET-CT. Front Med (Lausanne) 2022; 9:796085. [PMID: 35308500 PMCID: PMC8924656 DOI: 10.3389/fmed.2022.796085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the reproducibility of tracer uptake measurements, including volume metrics, such as metabolic tumor volume (MTV) and tumor lesion glycolysis (TLG) obtained by TOF-PET-CT and TOF-PET-MR. Materials and Methods Eighty consecutive patients with different oncologic diagnoses underwent TOF-PET-CT (Discovery 690; GE Healthcare) and TOF-PET-MR (SIGNA PET-MR; GE Healthcare) on the same day with single dose−18F-FDG injection. The scan order, PET-CT following or followed by PET-MR, was randomly assigned. A spherical volume of interest (VOI) of 30 mm was placed on the liver in accordance with the PERCIST criteria. For liver, the maximum and mean standard uptake value for body weight (SUV) and lean body mass (SUL) were obtained. For tumor delineation, VOI with a threshold of 40 and 50% of SUVmax was used (VOI40 and VOI50). The SUVmax, SUVmean, SUVpeak, MTV and TLG were calculated. The measurements were compared between the two scanners. Results In total, 80 tumor lesions from 35 patients were evaluated. There was no statistical difference observed in liver regions, whereas in tumor lesions, SUVmax, SUV mean, and SUVpeak of PET-MR were significantly underestimated (p < 0.001) in both VOI40 and VOI50. Among volume metrics, there was no statistical difference observed except TLG on VOI50 (p = 0.03). Correlation between PET-CT and PET-MR of each metrics were calculated. There was a moderate correlation of the liver SUV and SUL metrics (r = 0.63–0.78). In tumor lesions, SUVmax and SUVmean had a stronger correlation with underestimation in PET-MR on VOI 40 (SUVmax and SUVmean; r = 0.92 and 0.91 with slope = 0.71 and 0.72, respectively). In the evaluation of MTV and TLG, the stronger correlations were observed both on VOI40 (MTV and TLG; r = 0.75 and 0.92) and VOI50 (MTV and TLG; r = 0.88 and 0.95) between PET-CT and PET-MR. Conclusion PET metrics on TOF-PET-MR showed a good correlation with that of TOF-PET-CT. SUVmax and SUVpeak of tumor lesions were underestimated by 16% on PET-MRI. MTV with % threshold can be regarded as identical volumetric markers for both TOF-PET-CT and TOF-PET-MR.
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Affiliation(s)
- Aruki Tanaka
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan.,Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan.,Departments of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Edwin E G W Ter Voert
- Departments of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Konstantinos G Zeimpekis
- Departments of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Felipe de Galiza Barbosa
- Departments of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Geoffrey Warnock
- Departments of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,PMOD Technologies Ltd., Zurich, Switzerland
| | | | - Patrick Veit Haibach
- Departments of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Martin Huellner
- Departments of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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Høilund-Carlsen PF, Gerke O. Sources of error with cardiovascular PET/CT and PET/MRI and questions to be answered to achieve clinical usefulness. J Nucl Cardiol 2021; 28:2421. [PMID: 34291372 DOI: 10.1007/s12350-021-02750-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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