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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 2/2016

01-02-2016 | Original Article

High-risk plaque features can be detected in non-stenotic carotid plaques of patients with ischaemic stroke classified as cryptogenic using combined 18F-FDG PET/MR imaging

Authors: Fabien Hyafil, Andreas Schindler, Dominik Sepp, Tilman Obenhuber, Anna Bayer-Karpinska, Tobias Boeckh-Behrens, Sabine Höhn, Marcus Hacker, Stephan G. Nekolla, Axel Rominger, Martin Dichgans, Markus Schwaiger, Tobias Saam, Holger Poppert

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 2/2016

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Abstract

Purpose

The aim of this study was to investigate in 18 patients with ischaemic stroke classified as cryptogenic and presenting non-stenotic carotid atherosclerotic plaques the morphological and biological aspects of these plaques with magnetic resonance imaging (MRI) and 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) imaging.

Methods

Carotid arteries were imaged 150 min after injection of 18F-FDG with a combined PET/MRI system. American Heart Association (AHA) lesion type and plaque composition were determined on consecutive MRI axial sections (n = 460) in both carotid arteries. 18F-FDG uptake in carotid arteries was quantified using tissue to background ratio (TBR) on corresponding PET sections.

Results

The prevalence of complicated atherosclerotic plaques (AHA lesion type VI) detected with high-resolution MRI was significantly higher in the carotid artery ipsilateral to the ischaemic stroke as compared to the contralateral side (39 vs 0 %; p = 0.001). For all other AHA lesion types, no significant differences were found between ipsilateral and contralateral sides. In addition, atherosclerotic plaques classified as high-risk lesions with MRI (AHA lesion type VI) were associated with higher 18F-FDG uptake in comparison with other AHA lesions (TBR = 3.43 ± 1.13 vs 2.41 ± 0.84, respectively; p < 0.001). Furthermore, patients presenting at least one complicated lesion (AHA lesion type VI) with MRI showed significantly higher 18F-FDG uptake in both carotid arteries (ipsilateral and contralateral to the stroke) in comparison with carotid arteries of patients showing no complicated lesion with MRI (mean TBR = 3.18 ± 1.26 and 2.80 ± 0.94 vs 2.19 ± 0.57, respectively; p < 0.05) in favour of a diffuse inflammatory process along both carotid arteries associated with complicated plaques.

Conclusion

Morphological and biological features of high-risk plaques can be detected with 18F-FDG PET/MRI in non-stenotic atherosclerotic plaques ipsilateral to the stroke, suggesting a causal role for these plaques in stroke. Combined 18F-FDG PET/MRI systems might help in the evaluation of patients with ischaemic stroke classified as cryptogenic.
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Metadata
Title
High-risk plaque features can be detected in non-stenotic carotid plaques of patients with ischaemic stroke classified as cryptogenic using combined 18F-FDG PET/MR imaging
Authors
Fabien Hyafil
Andreas Schindler
Dominik Sepp
Tilman Obenhuber
Anna Bayer-Karpinska
Tobias Boeckh-Behrens
Sabine Höhn
Marcus Hacker
Stephan G. Nekolla
Axel Rominger
Martin Dichgans
Markus Schwaiger
Tobias Saam
Holger Poppert
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 2/2016
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-015-3201-8

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