Radionuclide imaging of inflammation in atherosclerotic vascular disease among people living with HIV infection: current practice and future perspective

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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“…These changes create an inflammatory milieu in the vessel wall. The utility of radionuclide agents for targeting vessel intima changes in endothelial injury has been recently reviewed by us and others [ 72 , 73 ]. Radionuclide imaging by positron emission tomography (PET) provides a sensitive avenue for non-invasive imaging of in vivo biologic processes.…”

FDG PET/CT for evaluating systemic arterial inflammation induced by anthracycline-based chemotherapy of Hodgkin lymphoma

“…Arterial inflammation measured by the intensity of arterial FDG uptake is known to be higher in HIV-infected people compared with age- and gender-matched controls. [ 15 , 31 ] We compared the changes in arterial FDG uptake between HIV-infected and HIV-uninfected patients and found no significant difference in the 2 groups. Similarly, in a sub-group analysis where we compared patients who were smokers and those who were hypertensive versus those who were not, we found no significant difference in the groups based on these 2 variables.…”

Impact of optimized PET imaging conditions on 18F-FDG uptake quantification in patients with apparently normal aortas

“…Inflammation plays an important role in the formation and progression of vascular atheroma. 3 Agents with anti-inflammatory effects are now being evaluated for their potential for primary and secondary prevention of atherosclerotic cardiovascular diseases. 19 18 F-FDG PET/ CT holds a great potential for non-invasive evaluation of the effectiveness of these therapy agents.…”

“…There are now concerted efforts to develop more specific tracers which do not suffer from these drawbacks experienced with 18 F-FDG use. 3,21,22 Our study is unique in the fact that we compared two sets of imaging conditions, one optimized for vascular inflammation imaging and the other not, in the same set of patients in a test-retest setting. Our study design allows for each patient to serve as their own control which removes inter-individual variability as a confounding factor.…”

“…2 Radionuclide methods are a viable tool for imaging of vascular inflammation. 3 Fluorine-18 Fluorodeoxyglucose ( 18 F-FDG) positron emission tomography with computed tomography (PET/CT) is the most used radionuclide technique for vascular and cardiac inflammation and infection imaging. 4 18 F-FDG accumulates more in vessels of individuals at higher risk of cardiovascular disease.…”