Molecular imaging of vascular inflammation
Nobuhiro Tahara, Atsuko Tahara, Akihiro Honda
1Department of Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan. ntahara@med.kurume-u.ac.jp.
Insights
Positron emission tomography (PET) imaging with 18F-fluorodeoxyglucose (FDG) can identify vulnerable atherosclerotic plaques by detecting macrophage activation. This molecular imaging approach may help identify patients at risk for cardiovascular events.
Area of Science:
- Cardiovascular Imaging
- Molecular Imaging
- Vascular Inflammation
Background:
- Atherosclerosis and its thrombotic complications are leading causes of death globally.
- Vulnerable atherosclerotic plaques, characterized by specific compositional features, are key to cardiovascular disease pathogenesis.
- Macrophage activation within plaques drives vascular inflammation and instability, contributing to acute coronary syndromes.
Purpose of the Study:
- To review the clinical utility of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging.
- To explore FDG-PET's capability in identifying vulnerable atherosclerotic plaques.
- To assess FDG-PET's potential in evaluating therapeutic efficacy for plaque instability.
Main Methods:
- Review of existing literature on imaging modalities for plaque vulnerability.
- Focus on molecular imaging, specifically FDG-PET, for detecting macrophage activity.
- Comparison with conventional imaging techniques like CT angiography, MRI, IVUS, and OCT.
Main Results:
- FDG-PET can identify and quantify vascular inflammation associated with macrophage activation in atherosclerotic plaques.
- Molecular imaging is superior for detecting metabolically active macrophages compared to morphological imaging.
- FDG-PET shows promise as a clinical tool for vulnerable plaque detection.
Conclusions:
- FDG-PET imaging is a valuable tool for identifying metabolically active macrophages in atherosclerotic plaques.
- This technique may aid in identifying patients at high risk for plaque rupture and cardiovascular events.
- FDG-PET could be instrumental in assessing the effectiveness of treatments targeting plaque instability.
Abstract:
Atherosclerosis and its thrombotic complications represent the major cause of morbidity and mortality in the industrialized countries. Despite recent advances in the diagnosis and management of cardiovascular disease, a substantial number of patients still die from acute coronary syndromes. Recently, atherosclerotic plaque composition rather than the degree of arterial stenosis has been shown to reflect the plaque vulnerability, thus contributing to the pathogenesis of cardiovascular disease. Vulnerable plaques have a large lipidrich necrotic core, a thin-fibrous cap and numerous inflammatory cells. Among them, macrophage activation plays a central role in vascular inflammation and plaque instability within the atherosclerosis, being strongly involved in acute coronary syndromes. Various morphologic features of plaque vulnerability have been described by computed tomography angiography, magnetic resonance imaging, intravascular ultrasound, and optical coherence tomography. Molecular imaging is the tool best suited for identifying metabolically active macrophages. Indeed, positron emission tomography (PET) imaging with 18F-fluorodeoxyglucose (FDG) is capable of identifying and quantifying vascular inflammation characterized by macrophage activation within the atherosclerotic plaques. So, FDG-PET might be a feasible clinical tool for detecting vulnerable plaques and evaluating the efficacy of drugs in plaque instability. In this paper, we review the clinical utility of FDG-PET imaging in identifying patients at risk of plaque rupture and resultantly prone to cardiovascular disease.
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