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High-risk plaque features can be detected in non-stenotic carotid plaques of patients with ischaemic stroke classified as cryptogenic using combined 18F-FDG PET/MR imaging

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to investigate in 18 patients with ischaemic stroke classified as cryptogenic and presenting non-stenotic carotid atherosclerotic plaques the morphological and biological aspects of these plaques with magnetic resonance imaging (MRI) and 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) imaging.

Methods

Carotid arteries were imaged 150 min after injection of 18F-FDG with a combined PET/MRI system. American Heart Association (AHA) lesion type and plaque composition were determined on consecutive MRI axial sections (n = 460) in both carotid arteries. 18F-FDG uptake in carotid arteries was quantified using tissue to background ratio (TBR) on corresponding PET sections.

Results

The prevalence of complicated atherosclerotic plaques (AHA lesion type VI) detected with high-resolution MRI was significantly higher in the carotid artery ipsilateral to the ischaemic stroke as compared to the contralateral side (39 vs 0 %; p = 0.001). For all other AHA lesion types, no significant differences were found between ipsilateral and contralateral sides. In addition, atherosclerotic plaques classified as high-risk lesions with MRI (AHA lesion type VI) were associated with higher 18F-FDG uptake in comparison with other AHA lesions (TBR = 3.43 ± 1.13 vs 2.41 ± 0.84, respectively; p < 0.001). Furthermore, patients presenting at least one complicated lesion (AHA lesion type VI) with MRI showed significantly higher 18F-FDG uptake in both carotid arteries (ipsilateral and contralateral to the stroke) in comparison with carotid arteries of patients showing no complicated lesion with MRI (mean TBR = 3.18 ± 1.26 and 2.80 ± 0.94 vs 2.19 ± 0.57, respectively; p < 0.05) in favour of a diffuse inflammatory process along both carotid arteries associated with complicated plaques.

Conclusion

Morphological and biological features of high-risk plaques can be detected with 18F-FDG PET/MRI in non-stenotic atherosclerotic plaques ipsilateral to the stroke, suggesting a causal role for these plaques in stroke. Combined 18F-FDG PET/MRI systems might help in the evaluation of patients with ischaemic stroke classified as cryptogenic.

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Acknowledgments

We thank Sylvia Schachoff, Anna Winter, and Claudia Meisinger for their valuable help in acquiring PET/MR images in the patients of this study and Isabelle Dregelly for setting up MRI sequences.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The local Ethics Committee approved the study and all participants provided written informed consent.

Clinical Trial Registration: Unique Identifier NCT01284933; URL: https://clinicaltrials.gov

Funding sources

This work was supported by the Advanced Research Grant “Multimodal Molecular Imaging” (MUMI; Grant number: 294582; European Research Council Executive Agency) and by the Deutsche Forschungsgemeinschaft (DFG; Grossgeräteinitiative).

Conflicts of interest

Markus Schwaiger has a research cooperation contract with Siemens Healthcare AG. The other authors have no potential conflicts of interest relevant to this article.

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    Authors and Affiliations

    1. Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

      Fabien Hyafil, Stephan G. Nekolla & Markus Schwaiger

    2. Department of Nuclear Medicine, Bichat University Hospital, Inserm 1148, DHU FIRE, Assistance Publique – Hôpitaux de Paris, Paris, France

      Fabien Hyafil

    3. Institute for Clinical Radiology, Ludwig Maximilians University Hospital Munich, Munich, Germany

      Andreas Schindler, Tilman Obenhuber & Tobias Saam

    4. Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

      Dominik Sepp, Sabine Höhn, Martin Dichgans & Holger Poppert

    5. Institute for Stroke and Dementia Research, Ludwig Maximilians University Hospital Munich, Munich, Germany

      Anna Bayer-Karpinska

    6. Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany

      Tobias Boeckh-Behrens

    7. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

      Marcus Hacker

    8. German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany

      Stephan G. Nekolla

    9. Department of Nuclear Medicine, Ludwig Maximilians University Hospital Munich, Munich, Germany

      Axel Rominger

    10. Munich Cluster of Systems Neurology (SyNergy), Munich, Germany

      Martin Dichgans

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    1. Fabien Hyafil
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    Correspondence to Fabien Hyafil.

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    Fabien Hyafil and Andreas Schindler contributed equally to this work.

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    Hyafil, F., Schindler, A., Sepp, D. et al. High-risk plaque features can be detected in non-stenotic carotid plaques of patients with ischaemic stroke classified as cryptogenic using combined 18F-FDG PET/MR imaging. Eur J Nucl Med Mol Imaging 43, 270–279 (2016). https://doi.org/10.1007/s00259-015-3201-8

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