Positron emission tomography for diagnosing cerebrovascular disorders: a scoping review

Positron Emission Tomography (PET) is emerging as a valuable imaging modality in cerebrovascular disease, especially for detecting neuroinflammation and β-amyloid deposition in conditions such as primary angiitis of the central nervous system (PACNS) and cerebral amyloid angiopathy (CAA). Despite its potential, PET remains underutilized due to limited availability, high costs, and lack of standardized protocols. This scoping review synthesizes current evidence on the diagnostic and prognostic applications of PET in adult cerebrovascular disorders.

We systematically searched PubMed and Scopus through February 2026 using combinations of cerebrovascular and PET-related terms (e.g., "stroke," "CAA," "vasculitis," "FDG," "PiB," "amyloid"). Eligible studies employed PET tracers such as ^18F-FDG, ^11C-PiB, or ^18F-florbetaben; followed observational designs (cohort, cross-sectional, or case series); and reported clinical outcomes including stroke recurrence or cognitive decline. Risk of bias was assessed with the Newcastle-Ottawa Scale.

Among 10287 records screened, 42 met inclusion criteria. PET was most applied in CAA, and cryptogenic intracerebral hemorrhage. Amyloid PET demonstrated high sensitivity (85-91%) but limited specificity in diagnosing probable CAA. FDG-PET effectively identified vasculitic and inflammatory patterns, particularly in carotid arteries. Uptake patterns were associated with future stroke or cognitive deterioration in select cohorts.

PET imaging provides meaningful diagnostic and prognostic information in complex cerebrovascular cases. Further validation across centers and standardisation of acquisition and analysis protocols are needed to optimize clinical integration.