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Delayed time-point 18F-FDG PET CT imaging enhances assessment of atherosclerotic plaque inflammation

Blomberg, Björn A.a,b,e; Akers, Scott R.c; Saboury, Babaka,b; Mehta, Nehal N.d; Cheng, Gangc; Torigian, Drew A.a,b; Lim, Estherc; Del Bello, Catherinec; Werner, Thomas J.b; Alavi, Abassa,b

doi: 10.1097/MNM.0b013e3283637512
Original Articles

Objective The aim of this study was to determine the ideal circulation time of fluorine-18 fluorodeoxyglucose (18F-FDG) in order to detect and quantify atherosclerotic plaque inflammation with PET computed tomography (CT) imaging.

Methods Fifteen patients underwent multiple time-point imaging at ∼60, 120, and 180 min after 18F-FDG administration. For each time point, global assessment of aortic and carotid 18F-FDG uptake was determined qualitatively by visual assessment and semiquantitatively by calculation of the mean and maximum standardized uptake values (SUV) and the corresponding target-to-background ratio (TBR).

Results Delayed imaging achieved significant improvement in visualization of atherosclerotic plaque inflammation [Friedman’s χ 2 statistic (d.f.=2, n=15)=24.13, P<0.001, Kendall’s W=0.80]. This observation was confirmed by semiquantitative image analysis. At 1 h, the aortic and carotid SUVmean-calculated TBR was 1.05 [95% confidence interval (CI)=0.98, 1.11] and 0.88 (95% CI=0.81, 0.96), respectively. At 3 h, the TBR significantly increased to 1.57 (95% CI=1.28, 1.86; P=0.001) for the aorta and to 1.61 (95% CI=1.36, 1.87; P<0.001) for the carotid arteries. SUVmax-calculated TBRs showed a similar increase over time.

Conclusion One- and 2-h 18F-FDG PET CT imaging is suboptimal for global assessment of atherosclerotic plaque inflammation compared with imaging at 3 h. Our data support the utilization of 3-h delayed imaging to obtain optimal data for the detection and quantification of atherosclerotic plaque inflammation in human arteries.

aPerelman School of Medicine at the University of Pennsylvania

bDepartment of Radiology, Hospital of the University of Pennsylvania

cDepartment of Radiology, Philadelphia VA Medical Center, Philadelphia, Pennsylvania

dNational Heart Lung and Blood Institute, Bethesda, Maryland, USA

eUniversity Medical Center Utrecht, Utrecht University School of Medicine, Utrecht, The Netherlands

Correspondence to Abass Alavi, MD, MD(Hon), PhD(Hon), DSc, 3400 Spruce Street, Philadelphia, PA 19104, USA Tel: +1 215 662 3069; fax: +1 215 746 0753; e-mail:

Received February 15, 2013

Accepted May 21, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins