Applications of FDG PET/CT in Atherosclerosis and Its Potential for Monitoring Therapeutic Responses

正子氟化去氧葡萄糖斷層造影在動脈硬化診療之應用

張智勇(Chih-Yung Chang) ； Cheng-Yi Cheng ； 施維貞(Wei-Jen Shih) ； 彭家勛(Giia-Sheun Peng) ； 曾大為(Ta-Wei Tzeng) ； 陳恩賜(En-Shih Chen) ； 黃文盛(Wen-Sheng Huang) ； 王晴兒(Ching-Yee Oliver Wong)

《Journal of Medical Sciences》 29卷3期 (2009/06) Pp. 107-117

https://doi.org/10.6136/JMS.2009.29(3).107

並列摘要

Cerebrovascular and heart diseases remain the main causes of death worldwide. The identification of high-risk groups for atherothrombosis, its prevention, and the initiation of treatment in very early disease stages are important in clinical practice. Recent advances in vascular biology have provided a better insight into the pathogenesis, clinical assessment, and management of these conditions. The atherothrombotic process is progressive and is prone to multiple involvements. Unstable atherosclerotic plaques activate platelets and the coagulation cascade, which can lead to the formation of a thrombus, vascular injury, transient ischemic attacks, stroke, myocardial infarction, and intermittent claudication. Several invasive and noninvasive radiological examination methods provide valuable insights on atherosclerotic plaques. In addition to anatomic information, the recent development of Computerized tomography (CT) and Magnetic resonance imaging (MRI) enable plaque characterization. A series of conventional nuclear medicine tracers have been developed for the detection of atherosclerosis; however, most of them are still under evaluation. Recently, it was found that glucose uptake is increased in activated inflammatory cells. This raises great interest in the potential applications of Fluorodeoxyglucose-positron emission tomography (FDG PET) to the evaluation of inflammatory and infectious disorders. Recent observations have revealed that stroke occurs more as a consequence of plaque composition than of lesion size. The inflammatory cell content of plaques is the most important factor of plaque rupture, because inflammatory cells, especially macrophages, destroy the plaque and release its thrombogenic contents into the bloodstream, which results in arterial embolization complications. The accumulation of F-18-FDG in inflamed atherosclerotic lesions enables the observation of the biological activity within plaques and of the relationship between plaque stability and clinical outcomes. The use of FDG PET in combination with CT allows the accurate localization of lesions. In addition, 3-hydroxy- 3-methylglutary coenzyme A (HMG-CoA) reductase inhibitors contribute to the stabilization of atherosclerotic plaques not only by reducing the circulating levels of atherogenic lipoproteins but also by resolving plaque inflammation; thus, F-18 FDG imaging may be useful for the monitoring of the therapeutic effects of these compounds, because the degree of FDG uptake correlates well with the extent of vascular inflammation.

並列關鍵字

FDG PET/CT ； atherosclerosis ； unstable plaque