PET Imaging of Atherosclerosis

Tarkin, Jason M.; Joshi, Francis R.; Rajani, Nikil K; Rudd, James H.F.

doi:10.2217/fca.14.55

Cited by 20 publications

(16 citation statements)

References 129 publications

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“…One such method is 18F-fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) combined with computed tomography (CT), which has been used in both preclinical and clinical studies for the evaluation of inflammation in the arterial wall [18,19,20,21,22]. Over the last few years, significant technical progresses have been achieved in order to extend the CV applications of 18F-FDG PET/CT, which include improved image acquisition, measurements, and reconstruction protocols [23].…”

Section: Introductionmentioning

confidence: 99%

Effect of Statin Therapy on Arterial Wall Inflammation Based on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis of Interventional Studies

Pirro

Simental‐Mendía

Bianconi

et al. 2019

JCM

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Aim. To evaluate by meta-analysis of interventional studies the effect of statin therapy on arterial wall inflammation. Background. Arterial exposure to low-density lipoprotein (LDL) cholesterol levels is responsible for initiation and progression of atherosclerosis and arterial wall inflammation. 18F-fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (18F-FDG PET/CT) has been used to detect arterial wall inflammation and monitor the vascular anti-inflammatory effects of lipid-lowering therapy. Despite a number of statin-based interventional studies exploring 18F-FDG uptake, these trials have produced inconsistent results. Methods. Trials with at least one statin treatment arm were searched in PubMed-Medline, SCOPUS, ISI Web of Knowledge, and Google Scholar databases. Target-to-background ratio (TBR), an indicator of blood-corrected 18F-FDG uptake, was used as the target variable of the statin anti-inflammatory activity. Evaluation of studies biases, a random-effects model with generic inverse variance weighting, and sensitivity analysis were performed for qualitative and quantitative data assessment and synthesis. Subgroup and meta-regression analyses were also performed. Results. Meta-analysis of seven eligible studies, comprising 10 treatment arms with 287 subjects showed a significant reduction of TBR following statin treatment (Weighted Mean Difference (WMD): −0.104, p = 0.002), which was consistent both in high-intensity (WMD: −0.132, p = 0.019) and low-to-moderate intensity statin trials (WMD: −0.069, p = 0.037). Statin dose/duration, plasma cholesterol and C-reactive protein level changes, and baseline TBR did not affect the TBR treatment response to statins. Conclusions. Statins were effective in reducing arterial wall inflammation, as assessed by 18F-FDG PET/CT imaging. Larger clinical trials should clarify whether either cholesterol-lowering or other pleiotropic mechanisms were responsible for this effect.

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Section: Introductionmentioning

confidence: 99%

Effect of Statin Therapy on Arterial Wall Inflammation Based on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis of Interventional Studies

Pirro

Simental‐Mendía

Bianconi

et al. 2019

JCM

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“…A number of clinical trials have indicated its value as a surrogate marker of treatment efficacy [58], for example using statins [59,60] or lipoprotein apheresis [61], while for niacin added to statin therapy, no additional benefi t was reported [62]. Particular problems arise when F-18-FDG is used in coronary artery lesions; several attempts have been made to improve the results, including a rather strict dietary intervention such as a one day high-fat low carbohydrate diet prior to scanning [63,64] to decrease myocardial glucose uptake as well as motion correction [65,66].…”

Section: Therapeutic Interventionmentioning

confidence: 99%

Molecular imaging of atherosclerotic lesions by positron emission tomography - can it meet the expectations?

Brammen

Steiner

Berent³

et al. 2016

Vasa

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Summary:Early non-invasive imaging of atherosclerosis and in particular the detection of lesions at risk with high specifi city could significantly affect cardiovascular morbidity and mortality. Conventional nuclear medicine approaches, in particular using autologous radiolabeled lipoproteins, can be related to histopathological fi ndings; however, they fail to identify lesions at risk. Positron emission tomography (PET) tracers with much better physical properties have been examined, the most detailed information being available for F-18-deoxyglucose (FDG) and F-18-sodium fl uoride (NaF). These two approaches are sensitive to different biochemical mechanisms, i.e. infl ammation and microcalcifi cation. Initial enthusiasm, in particular for F-18-FDG, has disappeared, although for F-18-NaF there is some hope, but this is not a breakthrough. No tracer is available so far that is able to identify a specifi c characteristic of a lesion prone to rupture. Other PET tracers in the pipeline have been examined, mainly in experimental models and only a few in patients, but they failed to contribute signifi cantly to early lesion discovery and do not support great expectations. The key question is: Do we understand what we see? Moreover, methodological problems, a lack of standardization of imaging protocols and aspects of quantifi cation provide a wide range for potential future improvements. While monitoring a therapeutic intervention seems to be possible for both F-18-FDG and F-18-NaF, highly specifi c early identifi cation of lesions at risk by PET imaging is still far away. As of today, PET is not ready for routine clinical judgment of atherosclerotic lesions at risk to rupture. Even if all these problems can be solved, radiation exposure will still remain a concern, in particular for repeated studies.

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“…In addition, small business innovative research (SBIR) grants and small business technology transfer (STTR) grants can provide the funds to demonstrate proof of concept for innovative device projects that involve more research or risk than the market will generally tolerate. (22)…”

Section: Funding and Return On Investmentmentioning

confidence: 99%

Proceedings from Heart Rhythm Society’s emerging technologies forum, Boston, MA, May 12, 2015

et al. 2016

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Physicians are in an excellent position to significantly contribute to medical device innovation, but the process of bringing an idea to the bedside is complex. To begin to address these perceived barriers, the Heart Rhythm Society (HRS) convened a forum of stakeholders in medical device innovation in conjunction with the 2015 HRS Scientific Sessions. The forum facilitated open discussion about medical device innovation, including obstacles to physician involvement and possible solutions. This report is based on the themes that emerged. First, physician innovators must take an organized approach to identifying unmet clinical needs and potential solutions. Second, extensive funds, usually secured through solicitation for investment, are often required to achieve meaningful progress developing an idea into a device. Third, planning for regulatory requirements of the U.S. Food & Drug Administration (FDA) and Centers for Medicare and Medicaid Services (CMS) is essential. In addition to these issues, intellectual property and overall trends in health care, including international markets, are critically relevant considerations for the physician innovator. Importantly, there are a number of ways in which professional societies can assist physician innovators to navigate the complex medical device innovation landscape, bring clinically meaningful devices to market more quickly, and ultimately improve patient care. These efforts include facilitating interaction between potential collaborators through scientific meetings and other gatherings; collecting, evaluating, and disseminating state-of-the-art scientific information; and representing the interests of members in interactions with regulators and policy makers.

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PET Imaging of Atherosclerosis

Cited by 20 publications

References 129 publications

Effect of Statin Therapy on Arterial Wall Inflammation Based on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis of Interventional Studies

Effect of Statin Therapy on Arterial Wall Inflammation Based on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis of Interventional Studies

Molecular imaging of atherosclerotic lesions by positron emission tomography - can it meet the expectations?

Proceedings from Heart Rhythm Society’s emerging technologies forum, Boston, MA, May 12, 2015

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