Skip to main content
Top
Published in: European Journal of Nuclear Medicine and Molecular Imaging 1/2017

01-01-2017 | Original Article

Prediction of coronary artery calcium progression by FDG uptake of large arteries in asymptomatic individuals

Authors: Sang-Geon Cho, Ki Seong Park, Jahae Kim, Sae-Ryung Kang, Seong Young Kwon, Hyun Ju Seon, Zeenat Jabin, Young Jae Kim, Geum-Cheol Jeong, Minchul Song, Ho-Chun Song, Jung-Joon Min, Hee-Seung Bom

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 1/2017

Login to get access

Abstract

Purpose

The purpose of this study is to evaluate whether fluorodeoxyglucose (FDG) uptake of the large arteries can predict coronary artery calcium (CAC) progression in asymptomatic individuals.

Methods

Ninety-six asymptomatic individuals who underwent FDG positron emission tomography (PET) and CAC scoring on the same day for health screening and follow-up CAC scoring ≥1 year after baseline studies (mean 4.3 years) were included. Vascular FDG uptake was measured and corrected for blood pool activity to obtain peak and average target-to-blood pool ratios (TBRpeak and TBRavg, respectively) for the carotid arteries, and ascending and abdominal aorta. CAC scores at baseline and follow-up of each individual were measured and absolute CAC change (ΔCAC), annual CAC change (ΔCAC/year), and annual CAC change rate (ΔCAC%/year) were calculated. CAC progression was defined as ΔCAC >0 for individuals with negative baseline CAC; ΔCAC/year ≥10 for those with baseline CAC of 0<x<100; ΔCAC%/year ≥10 % for those with baseline CAC ≥100. Vascular FDG uptake and other clinical risk factors were compared between CAC-progressors and non-CAC-progressors. Multivariate analysis was performed to evaluate whether vascular FDG uptake can independently predict CAC progression.

Results

Thirty-one subjects showed CAC progression. CAC-progressors showed significantly higher TBRpeak and TBRavg as compared to non-CAC-progressors for all three arteries. TBRpeak of the abdominal aorta was significantly associated with CAC progression in multivariate analysis, with age and baseline CAC. A higher TBRpeak of the abdominal aorta (≥2.11) was associated with CAC progression among subjects with negative baseline CAC only. In subjects with positive baseline CAC, only the amount of baseline CAC was significantly associated with CAC progression. However, the positive predictive value of the TBRpeak of the abdominal aorta was <40 % when age was <58 or baseline CAC was negative.

Conclusions

Higher FDG uptake of the large arteries is associated with an increased risk of CAC progression in asymptomatic subjects with negative baseline CAC. But its clinical application needs further validation.
Appendix
Available only for authorised users
Literature
1.
go back to reference Morin RL, Gerber TC, McCollough CH. Radiation dose in computed tomography of the heart. Circulation. 2003;107:917–22.CrossRefPubMed Morin RL, Gerber TC, McCollough CH. Radiation dose in computed tomography of the heart. Circulation. 2003;107:917–22.CrossRefPubMed
2.
go back to reference Budoff MJ, Hokanson JE, Nasir K, Shaw LJ, Kinney GL, Chow D, et al. Progression of coronary artery calcium predicts all-cause mortality. J Am Coll Cardiol Img. 2010;3:1229–36.CrossRef Budoff MJ, Hokanson JE, Nasir K, Shaw LJ, Kinney GL, Chow D, et al. Progression of coronary artery calcium predicts all-cause mortality. J Am Coll Cardiol Img. 2010;3:1229–36.CrossRef
3.
go back to reference Wong ND, Nelson JC, Granston T, Bertoni AG, Blumenthal RS, Carr JJ, et al. Metabolic syndrome, diabetes, and incidence and progression of coronary calcium. J Am Coll Cardiol Img. 2012;5:358–66.CrossRef Wong ND, Nelson JC, Granston T, Bertoni AG, Blumenthal RS, Carr JJ, et al. Metabolic syndrome, diabetes, and incidence and progression of coronary calcium. J Am Coll Cardiol Img. 2012;5:358–66.CrossRef
4.
go back to reference Okwuosa TM, Greenland P, Burke GL, Eng J, Cushman M, Michos ED, et al. Prediction of coronary artery calcium progression in individuals with low Framingham risk score: the multi-ethnic study of atherosclerosis. J Am Coll Cardiol Img. 2012;5:144–53.CrossRef Okwuosa TM, Greenland P, Burke GL, Eng J, Cushman M, Michos ED, et al. Prediction of coronary artery calcium progression in individuals with low Framingham risk score: the multi-ethnic study of atherosclerosis. J Am Coll Cardiol Img. 2012;5:144–53.CrossRef
6.
go back to reference Cassidy-Bushrow AE, Bielak LF, Sheedy PF, Turner ST, Kullo IJ, Lin X, et al. Coronary artery calcification progression is heritable. Circulation. 2007;116:25–31. Cassidy-Bushrow AE, Bielak LF, Sheedy PF, Turner ST, Kullo IJ, Lin X, et al. Coronary artery calcification progression is heritable. Circulation. 2007;116:25–31.
8.
go back to reference Budoff MJ. Progression of coronary calcium not as predictable as 1-2-3. Eur Heart J. 2014;35:2934–5.CrossRefPubMed Budoff MJ. Progression of coronary calcium not as predictable as 1-2-3. Eur Heart J. 2014;35:2934–5.CrossRefPubMed
9.
go back to reference Tarkin JM, Joshi FR, Rudd JH. PET imaging of inflammation in atherosclerosis. Nat Rev Cardiol. 2014;11:443–57.CrossRefPubMed Tarkin JM, Joshi FR, Rudd JH. PET imaging of inflammation in atherosclerosis. Nat Rev Cardiol. 2014;11:443–57.CrossRefPubMed
10.
go back to reference Abdelbaky A, Corsini E, Figueroa AL, Fontanez S, Subramanian S, Ferencik M, et al. Focal arterial inflammation precedes subsequent calcification in the same location: a longitudinal FDG-PET/CT study. Circ Cardiovasc Imaging. 2013;6:747–54.CrossRefPubMed Abdelbaky A, Corsini E, Figueroa AL, Fontanez S, Subramanian S, Ferencik M, et al. Focal arterial inflammation precedes subsequent calcification in the same location: a longitudinal FDG-PET/CT study. Circ Cardiovasc Imaging. 2013;6:747–54.CrossRefPubMed
11.
go back to reference Goyen M, Herborn CU, Kroger K, Lauenstein TC, Debatin JF, Ruehm SG. Detection of atherosclerosis: systemic imaging for systemic disease with whole-body three-dimensional MR angiography - initial experience. Radiology. 2003;227:277–82.CrossRefPubMed Goyen M, Herborn CU, Kroger K, Lauenstein TC, Debatin JF, Ruehm SG. Detection of atherosclerosis: systemic imaging for systemic disease with whole-body three-dimensional MR angiography - initial experience. Radiology. 2003;227:277–82.CrossRefPubMed
12.
go back to reference Rudd JHF, Myers KS, Bansilal S, Machac J, Woodward M, Fuster V, et al. Relationships among regional arterial inflammation, calcification, risk factors, and biomarkers: a prospective fluorodeoxyglucose positron-emission tomography/computed tomography imaging study. Circ Cardiovasc Imaging. 2009;2:107–15.CrossRefPubMedPubMedCentral Rudd JHF, Myers KS, Bansilal S, Machac J, Woodward M, Fuster V, et al. Relationships among regional arterial inflammation, calcification, risk factors, and biomarkers: a prospective fluorodeoxyglucose positron-emission tomography/computed tomography imaging study. Circ Cardiovasc Imaging. 2009;2:107–15.CrossRefPubMedPubMedCentral
13.
go back to reference Tahara N, Tahara A, Narula J, Imaizumi T. Statin therapy resolves coronary artery inflammation. J Am Coll Cardiol Img. 2013;6:1119–20.CrossRef Tahara N, Tahara A, Narula J, Imaizumi T. Statin therapy resolves coronary artery inflammation. J Am Coll Cardiol Img. 2013;6:1119–20.CrossRef
14.
go back to reference Tawakol A, Fayad ZA, Mogg R, Alon A, Klimas MT, Dansky H, et al. Intensification of statin therapy results in a rapid reduction in atherosclerotic inflammation: results of a multicenter fluorodeoxyglucose-positron emission tomography/computed tomography feasibility study. J Am Coll Cardiol. 2013;62:909–17.CrossRefPubMed Tawakol A, Fayad ZA, Mogg R, Alon A, Klimas MT, Dansky H, et al. Intensification of statin therapy results in a rapid reduction in atherosclerotic inflammation: results of a multicenter fluorodeoxyglucose-positron emission tomography/computed tomography feasibility study. J Am Coll Cardiol. 2013;62:909–17.CrossRefPubMed
15.
go back to reference Zeb I, Li D, Nasir K, Malpeso J, Batool A, Flores F, et al. Effect of statin treatment on coronary plaque progression - a serial coronary CT angiography study. Atherosclerosis. 2013;231:198–204. Zeb I, Li D, Nasir K, Malpeso J, Batool A, Flores F, et al. Effect of statin treatment on coronary plaque progression - a serial coronary CT angiography study. Atherosclerosis. 2013;231:198–204.
16.
go back to reference Oh JR, Seo JH, Chong A, Min JJ, Song HC, Kim YC, et al. Whole-body metabolic tumour volume of F-18-FDG PET/CT improves the prediction of prognosis in small cell lung cancer. Eur J Nucl Med Mol Imaging. 2012;39:925–35.CrossRefPubMed Oh JR, Seo JH, Chong A, Min JJ, Song HC, Kim YC, et al. Whole-body metabolic tumour volume of F-18-FDG PET/CT improves the prediction of prognosis in small cell lung cancer. Eur J Nucl Med Mol Imaging. 2012;39:925–35.CrossRefPubMed
17.
go back to reference Noh TS, Yoo J, Kim SW, Lee EJ, Choi JY, Kim BT, et al. Effects of coverage extent and slice skipping on mean and maximum arterial 18F-FDG uptake ratios in patients with carotid plaque. Ann Nucl Med. 2012;26:715–22. Noh TS, Yoo J, Kim SW, Lee EJ, Choi JY, Kim BT, et al. Effects of coverage extent and slice skipping on mean and maximum arterial 18F-FDG uptake ratios in patients with carotid plaque. Ann Nucl Med. 2012;26:715–22.
18.
go back to reference Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte Jr M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.CrossRefPubMed Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte Jr M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.CrossRefPubMed
19.
go back to reference Marzola MC, Saboury B, Chondrogiannis S, Rampin L, Grassetto G, Ferretti A, et al. Role of FDG PET/CT in investigating the mechanisms underlying atherosclerotic plaque formation and evolution. Rev Esp Med Nucl Imagen Mol. 2013;32:246–52.PubMed Marzola MC, Saboury B, Chondrogiannis S, Rampin L, Grassetto G, Ferretti A, et al. Role of FDG PET/CT in investigating the mechanisms underlying atherosclerotic plaque formation and evolution. Rev Esp Med Nucl Imagen Mol. 2013;32:246–52.PubMed
20.
go back to reference Jenny NS, Brown ER, Detrano R, Folsom AR, Saad MF, Shea S, et al. Associations of inflammatory markers with coronary artery calcification: results from the multi-ethnic study of atherosclerosis. Atherosclerosis. 2010;209:226–9.CrossRefPubMed Jenny NS, Brown ER, Detrano R, Folsom AR, Saad MF, Shea S, et al. Associations of inflammatory markers with coronary artery calcification: results from the multi-ethnic study of atherosclerosis. Atherosclerosis. 2010;209:226–9.CrossRefPubMed
21.
go back to reference Alman AC, Kinney GL, Tracy RP, Maahs DM, Hokanson JE, Rewers MJ, et al. Prospective association between inflammatory markers and progression of coronary artery calcification in adults with and without type 1 diabetes. Diabetes Care. 2013;36:1967–73.CrossRefPubMedPubMedCentral Alman AC, Kinney GL, Tracy RP, Maahs DM, Hokanson JE, Rewers MJ, et al. Prospective association between inflammatory markers and progression of coronary artery calcification in adults with and without type 1 diabetes. Diabetes Care. 2013;36:1967–73.CrossRefPubMedPubMedCentral
22.
go back to reference Tawakol A, Migrino RQ, Bashian GG, Bedri S, Vermylen D, Cury RC, et al. In vivo 18F-fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflammation in patients. J Am Coll Cardiol. 2006;48:1818–24.CrossRefPubMed Tawakol A, Migrino RQ, Bashian GG, Bedri S, Vermylen D, Cury RC, et al. In vivo 18F-fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflammation in patients. J Am Coll Cardiol. 2006;48:1818–24.CrossRefPubMed
23.
go back to reference Tawakol A, Migrino RQ, Hoffmann U, Abbara S, Houser S, Gewirtz H, et al. Noninvasive in vivo measurement of vascular inflammation with F-18 fluorodeoxyglucose positron emission tomography. J Nucl Cardiol. 2005;12:294–301.CrossRefPubMed Tawakol A, Migrino RQ, Hoffmann U, Abbara S, Houser S, Gewirtz H, et al. Noninvasive in vivo measurement of vascular inflammation with F-18 fluorodeoxyglucose positron emission tomography. J Nucl Cardiol. 2005;12:294–301.CrossRefPubMed
24.
go back to reference Meller J, Sahlmann CO, Scheel AK. 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med. 2007;48:35–45.PubMed Meller J, Sahlmann CO, Scheel AK. 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med. 2007;48:35–45.PubMed
25.
go back to reference Bleeker-Rovers CP, Vos FJ, Corstens FH, Oyen WJ. Imaging of infectious diseases using [18F] fluorodeoxyglucose PET. Q J Nucl Med Mol Imaging. 2008;52:17–29.PubMed Bleeker-Rovers CP, Vos FJ, Corstens FH, Oyen WJ. Imaging of infectious diseases using [18F] fluorodeoxyglucose PET. Q J Nucl Med Mol Imaging. 2008;52:17–29.PubMed
26.
go back to reference Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation. 1995;92:1355–74. Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation. 1995;92:1355–74.
27.
go back to reference McEvoy JW, Blaha MJ, Defilippis AP, Budoff MJ, Nasir K, Blumenthal RS, et al. Coronary artery calcium progression: an important clinical measurement? A review of published reports. J Am Coll Cardiol. 2010;56:1613–22.CrossRefPubMed McEvoy JW, Blaha MJ, Defilippis AP, Budoff MJ, Nasir K, Blumenthal RS, et al. Coronary artery calcium progression: an important clinical measurement? A review of published reports. J Am Coll Cardiol. 2010;56:1613–22.CrossRefPubMed
28.
go back to reference Blaha M, Budoff MJ, Shaw LJ, Khosa F, Rumberger JA, Berman D, et al. Absence of coronary artery calcification and all-cause mortality. J Am Coll Cardiol Img. 2009;2:692–700.CrossRef Blaha M, Budoff MJ, Shaw LJ, Khosa F, Rumberger JA, Berman D, et al. Absence of coronary artery calcification and all-cause mortality. J Am Coll Cardiol Img. 2009;2:692–700.CrossRef
29.
go back to reference Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffmann U, Cury RC, et al. Diagnostic and prognostic value of absence of coronary artery calcification. J Am Coll Cardiol Img. 2009;2:675–88.CrossRef Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffmann U, Cury RC, et al. Diagnostic and prognostic value of absence of coronary artery calcification. J Am Coll Cardiol Img. 2009;2:675–88.CrossRef
30.
go back to reference Nadra I, Mason JC, Philippidis P, Florey O, Smythe CD, McCarthy GM, et al. Proinflammatory activation of macrophages by basic calcium phosphate crystals via protein kinase C and MAP kinase pathways: a vicious cycle of inflammation and arterial calcification? Circ Res. 2005;96:1248–56.CrossRefPubMed Nadra I, Mason JC, Philippidis P, Florey O, Smythe CD, McCarthy GM, et al. Proinflammatory activation of macrophages by basic calcium phosphate crystals via protein kinase C and MAP kinase pathways: a vicious cycle of inflammation and arterial calcification? Circ Res. 2005;96:1248–56.CrossRefPubMed
31.
go back to reference Joshi FR, Rajani NK, Abt M, Woodward M, Bucerius J, Mani V, et al. Does vascular calcification accelerate inflammation? A substudy of the dal-PLAQUE trial. J Am Coll Cardiol. 2016;67:69–78.CrossRefPubMed Joshi FR, Rajani NK, Abt M, Woodward M, Bucerius J, Mani V, et al. Does vascular calcification accelerate inflammation? A substudy of the dal-PLAQUE trial. J Am Coll Cardiol. 2016;67:69–78.CrossRefPubMed
32.
go back to reference Hertzer NR, Beven EG, Young JR, O’Hara PJ, Ruschhaupt WF 3rd, Graor RA, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984;199:223–33. Hertzer NR, Beven EG, Young JR, O’Hara PJ, Ruschhaupt WF 3rd, Graor RA, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984;199:223–33.
33.
go back to reference von Kemp K, van den Brande P, Peterson T, Waegeneers S, Scheerlinck T, Danau W, et al. Screening for concomitant diseases in peripheral vascular patients. Results of a systematic approach. Int Angiol. 1997;16:114–22. von Kemp K, van den Brande P, Peterson T, Waegeneers S, Scheerlinck T, Danau W, et al. Screening for concomitant diseases in peripheral vascular patients. Results of a systematic approach. Int Angiol. 1997;16:114–22.
34.
go back to reference Myers KS, Rudd JHF, Hailman EP, Bolognese JA, Burke J, Pinto CA, et al. Correlation between arterial FDG uptake and biomarkers in peripheral artery disease. J Am Coll Cardiol Img. 2012;5:38–45.CrossRef Myers KS, Rudd JHF, Hailman EP, Bolognese JA, Burke J, Pinto CA, et al. Correlation between arterial FDG uptake and biomarkers in peripheral artery disease. J Am Coll Cardiol Img. 2012;5:38–45.CrossRef
35.
go back to reference Purohit BS, Ailianou A, Dulguerov N, Becker CD, Ratib O, Becker M. FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging. 2014;5:585–602.CrossRefPubMedPubMedCentral Purohit BS, Ailianou A, Dulguerov N, Becker CD, Ratib O, Becker M. FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging. 2014;5:585–602.CrossRefPubMedPubMedCentral
36.
go back to reference Kang WJ, Chung JK, So Y, Jeong JM, Lee DS, Lee MC. Differentiation of mediastinal FDG uptake observed in patients with non-thoracic tumours. Eur J Nucl Med Mol Imaging. 2004;31:202–7.CrossRefPubMed Kang WJ, Chung JK, So Y, Jeong JM, Lee DS, Lee MC. Differentiation of mediastinal FDG uptake observed in patients with non-thoracic tumours. Eur J Nucl Med Mol Imaging. 2004;31:202–7.CrossRefPubMed
37.
go back to reference Kronmal RA, McClelland RL, Detrano R, Shea S, Lima JA, Cushman M, et al. Risk factors for the progression of coronary artery calcification in asymptomatic subjects: results from the multi-ethnic study of atherosclerosis (MESA). Circulation. 2007;115:2722–30.CrossRefPubMed Kronmal RA, McClelland RL, Detrano R, Shea S, Lima JA, Cushman M, et al. Risk factors for the progression of coronary artery calcification in asymptomatic subjects: results from the multi-ethnic study of atherosclerosis (MESA). Circulation. 2007;115:2722–30.CrossRefPubMed
38.
go back to reference Lee KK, Fortmann SP, Fair JM, Iribarren C, Rubin GD, Varady A, et al. Insulin resistance independently predicts the progression of coronary artery calcification. Am Heart J. 2009;157:939–45.CrossRefPubMed Lee KK, Fortmann SP, Fair JM, Iribarren C, Rubin GD, Varady A, et al. Insulin resistance independently predicts the progression of coronary artery calcification. Am Heart J. 2009;157:939–45.CrossRefPubMed
39.
go back to reference Fairweather D. Sex differences in inflammation during atherosclerosis. Clin Med Insights Cardiol. 2014;8 Suppl 3:49–59.PubMed Fairweather D. Sex differences in inflammation during atherosclerosis. Clin Med Insights Cardiol. 2014;8 Suppl 3:49–59.PubMed
Metadata
Title
Prediction of coronary artery calcium progression by FDG uptake of large arteries in asymptomatic individuals
Authors
Sang-Geon Cho
Ki Seong Park
Jahae Kim
Sae-Ryung Kang
Seong Young Kwon
Hyun Ju Seon
Zeenat Jabin
Young Jae Kim
Geum-Cheol Jeong
Minchul Song
Ho-Chun Song
Jung-Joon Min
Hee-Seung Bom
Publication date
01-01-2017
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 1/2017
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-016-3523-1

Other articles of this Issue 1/2017

European Journal of Nuclear Medicine and Molecular Imaging 1/2017 Go to the issue

Reply

Reply