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The cardiosplenic axis: another obscure pathophysiological function of the spleen and its investigation using
Alexander Dunford1, Georgia Keramida, Constantinos D Anagnostopoulos
1aDepartment of Nuclear Medicine, Royal Sussex County Hospital, Brighton bClinical Imaging Sciences Centre, Brighton Sussex Medical School, Brighton cRoyal Brompton and Harefield NHS Foundation Trust, London, UK dCenter for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation Academy of Athens, Athens, Greece.
Insights
The spleen
Area of Science:
- Cardiovascular Medicine
- Immunology
- Radiology
Background:
- The spleen's role in cardiovascular disease, particularly atherosclerosis post-myocardial infarction, is increasingly recognized via the cardiosplenic axis.
- Current research often uses fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT to assess inflammation and splenic activity.
- Standardized uptake value (SUV) is a common but limited metric for metabolic activity due to factors like obesity and glucose levels.
Purpose of the Study:
- To highlight the limitations of current methods for measuring splenic metabolic activity in the context of the cardiosplenic axis.
- To advocate for advanced imaging techniques for more accurate assessment of splenic function in cardiovascular studies.
- To emphasize the need for improved methodologies in human studies investigating the cardiosplenic axis.
Main Methods:
- Review of existing human studies utilizing F-FDG PET/CT to investigate the cardiosplenic axis.
- Discussion of the limitations associated with the standardized uptake value (SUV) for quantifying metabolic activity.
- Introduction of dynamic imaging with Patlak-Rutland graphical analysis as a superior method for measuring F-FDG clearance and metabolic activity.
Main Results:
- The standardized uptake value (SUV) method for assessing splenic metabolic activity is semiquantitative and prone to inaccuracies.
- Overestimation of metabolic activity can occur in overweight individuals using SUV.
- Blood glucose levels significantly influence SUV measurements, impacting reliability.
Conclusions:
- Dynamic imaging and Patlak-Rutland graphical analysis offer a more accurate and reliable method for measuring F-FDG uptake and clearance.
- This advanced approach is recommended for future human studies on the cardiosplenic axis.
- Accurate measurement of splenic metabolic activity is crucial for understanding its role in atherosclerosis progression.
Abstract:
Splenic pathophysiology has been relatively unstudied, but recently, the spleen has received more attention as a result of the discovery of the 'cardiosplenic axis'. This term describes a role that the spleen plays in the progression of atherosclerosis following acute myocardial infarction. Human studies of this axis have largely used fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT to quantify peri-infarction inflammation, arterial wall inflammation and splenic metabolic activity. Most of these studies have quantified arterial wall inflammation and splenic metabolic activity using the standardized uptake value, but this is a semiquantitative measurement with several drawbacks, including overestimation of metabolic activity in overweight individuals and a dependence on blood glucose levels. A better approach to the measurement of metabolic activity using F-FDG is to measure tissue F-FDG clearance from dynamic imaging and Patlak-Rutland graphical analysis. This is the preferred approach for future human studies of the cardiosplenic axis that will be required to better define the nature of the spleen's role.
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