Validation of FDG Uptake in the Arterial Wall as an Imaging Biomarker of Atherosclerotic Plaques with ¹⁸F‐Fluorodeoxyglucose Positron Emission Tomography‐Computed Tomography (FDG‐PET/CT)

Abstract

Background and Purpose From the literature the prevalence of FDG uptake in large artery atherosclerotic plaques shows great heterogeneity. We retrospectively reviewed 100 consecutive patients who underwent FDG-PET/CT imaging of their whole body, to evaluate FDG uptake in the arterial wall. Materials & Methods We retrospectively evaluated 100 whole-body PET-CT scans. The PET co-registered CT images were reviewed with for abnormal 18F-FDG uptake. The mean standard uptake value (SUV) was measured in regions of interest (ROIs). The prevalence of PET+ plaques was determined based on the qualitative PET review, used as the gold standard in a receiver-operating characteristic (ROC) curve analysis to determine an optimal threshold for the quantitative PET analysis. Results The qualitative, visual assessment demonstrated FDG uptake in the arterial walls of 26 patients. A total of 85 slices exhibited FDG uptake within the arterial wall of 37 artery locations. 11, 17 and 2 patients exhibited FDG uptake respectively within the wall of carotid arteries of the aorta, and of the iliac arteries. Only 4 of the 26 patients had positive FDG uptake in more than one artery location. In terms of quantitative analysis, a threshold of 2.8 SUV was associated with a negative predictive value of 99.4% and a positive predictive value of 100% to predict qualitative PET+ plaques. A threshold of 1.8 SUV was associated with a negative predictive value of 100% and a positive predictive value of 99.4%. Area under the ROC curve was 0.839. Conclusion The prevalence of PET uptake in arterial walls in a consecutive population of asymptomatic patients is low and usually confined to one type of artery and its clinical relevance in terms of vulnerability to ischemic events remains to be determined.

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