Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug 11;12(8):e0181847.
doi: 10.1371/journal.pone.0181847. eCollection 2017.

Variability in quantitative analysis of atherosclerotic plaque inflammation using 18F-FDG PET/CT

Karel-Jan D F Lensen  1 , Alper M van Sijl  2 , Alexandre E Voskuyl  2 , Conny J van der Laken  2 , Martijn W Heymans  3 , Emile F I Comans  4 , Mike T Nurmohamed  2 , Yvo M Smulders  1 , Ronald Boellaard  4
Affiliations

Variability in quantitative analysis of atherosclerotic plaque inflammation using 18F-FDG PET/CT

Karel-Jan D F Lensen et al. PLoS One. .

Abstract

Background: 18F-FDG-PET(/CT) is increasingly used in studies aiming at quantifying atherosclerotic plaque inflammation. Considerable methodological variability exists. The effect of data acquisition and image analysis parameters on quantitative uptake measures, such as standardized uptake value (SUV) and target-to-background ratio (TBR) has not been investigated extensively.

Objective: The goal of this study was to explore the effect of several data acquisition and image analysis parameters on quantification of vascular wall 18F-FDG uptake measures, in order to increase awareness of potential variability.

Methods: Three whole-body emission scans and a low-dose CT scan were acquired 38, 60 and 90 minutes after injection of 18F-FDG in six rheumatoid arthritis patients with high cardiovascular risk profiles.Data acquisition (1 and 2) and image analysis (3, 4 and 5) parameters comprised:1. 18F-FDG uptake time, 2. SUV normalisation, 3. drawing regions/volumes of interest (ROI's/VOI's) according to: a. hot-spot (HS), b. whole-segment (WS) and c. most-diseased segment (MDS), 4. Background activity, 5. Image matrix/voxel size.Intraclass correlation coefficients (ICC's) and Bland Altman plots were used to assess agreement between these techniques and between observers. A linear mixed model was used to determine the association between uptake time and continuous outcome variables.

Results: 1. Significantly higher TBRmax values were found at 90 minutes (1,57 95%CI 1,35-1,80) compared to 38 minutes (1,30 95%CI 1,21-1,39) (P = 0,024) 2. Normalising SUV for BW, LBM and BSA significantly influences average SUVmax (2,25 (±0,60) vs 1,67 (±0,37) vs 0,058 (±0,013)). 3. Intraclass correlation coefficients were high in all vascular segments when SUVmax HS was compared to SUVmax WS. SUVmax HS was consistently higher than SUVmax MDS in all vascular segments. 4. Blood pool activity significantly decreases in all (venous and arterial) segments over time, but does not differ between segments. 5. Image matrix/voxel size does not influence SUVmax.

Conclusion: Quantitative measures of vascular wall 18F-FDG uptake are affected mainly by changes in data acquisition parameters. Standardization of methodology needs to be considered when studying atherosclerosis and/or vasculitis.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Clustered error plots of TBRmax and SUVmax at all three uptake times in the vascular segments of the aorta.
Fig 2
Fig 2. Scatter plot for SUVmax HS versus SUVmax WS. (HS = hot spot, WS = whole segment).
Fig 3
Fig 3. Scatter plots for observer agreement for whole-segment (Figure A.) and Hot-spot (Figure B) method.
Fig 4
Fig 4. Box plots of blood pool activity expressed as SUVmean in the ascending aorta and inferior and superior vena cava after 38, 60 and 90 minutes of fluorodeoxyglucose (FDG) uptake.
(SUVmean = mean standardized uptake value, CoV = coefficient of variation).
See this image and copyright information in PMC

References

    1. Ben-Haim S, Kupzov E, Tamir A, Israel O (2004) Evaluation of 18F-FDG uptake and arterial wall calcifications using 18F-FDG PET/CT. J Nucl Med 45: 1816–1821. - PubMed
    1. Rudd JH, Warburton EA, Fryer TD, Jones HA, Clark JC, Antoun N et al. (2002) Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation 105: 2708–2711. - PubMed
    1. Libby P (2013) Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med 368: 2004–2013. doi: 10.1056/NEJMra1216063 - DOI - PubMed
    1. Boellaard R, O'Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG et al. (2010) FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 37: 181–200. doi: 10.1007/s00259-009-1297-4 - DOI - PMC - PubMed
    1. Bucerius J, Hyafil F, Verberne HJ, Slart RH, Lindner O, Sciagra R et al. (2015) Position paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM) on PET imaging of atherosclerosis. Eur J Nucl Med Mol Imaging. doi: 10.1007/s00259-015-3259-3 - DOI - PMC - PubMed

Substances