Parametric Imaging of Biologic Activity of Atherosclerosis Using Dynamic Whole-Body Positron Emission Tomography

Thorsten Derlin; Rudolf A Werner; Desiree Weiberg; Katja Derlin; Frank M Bengel

doi:10.1016/j.jcmg.2022.05.008

Parametric Imaging of Biologic Activity of Atherosclerosis Using Dynamic Whole-Body Positron Emission Tomography

JACC Cardiovasc Imaging. 2022 Dec;15(12):2098-2108. doi: 10.1016/j.jcmg.2022.05.008. Epub 2022 Aug 17.

Authors

Thorsten Derlin¹, Rudolf A Werner², Desiree Weiberg², Katja Derlin³, Frank M Bengel²

Affiliations

¹ Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany. Electronic address: Derlin.Thorsten@mh-hannover.de.
² Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany.
³ Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.

PMID: 36481078
DOI: 10.1016/j.jcmg.2022.05.008

Abstract

Background: For molecular imaging of atherosclerotic vessel wall activity, tracer kinetic analysis may yield improved contrast versus blood, more robust quantitative parameters, and more reliable characterization of systems biology.

Objectives: The authors introduce a novel dynamic whole-body positron emission tomography (PET) protocol that is enabled by rapid continuous camera table motion, followed by reconstruction of parametric data sets using voxel-based Patlak graphical analysis.

Methods: Twenty-five subjects were prospectively enrolled and underwent dynamic PET up to 90 minutes after injection of 2-[¹⁸F]fluoro-2-deoxy-D-glucose (FDG). Two sets of images were generated: 1) the established standard of static standardized uptake value (SUV) images; and 2) parametric images of the metabolic rate of FDG (MR_FDG) using the Patlak plot-derived influx rate. Arterial wall signal was measured and compared using the volume-of-interest technique, and its association with hematopoietic and lymphoid organ signal and atherosclerotic risk factors was explored.

Results: Parametric MR_FDG images provided excellent arterial wall visualization, with elimination of blood-pool activity, and enhanced focus detectability and reader confidence. Target-to-background ratio (TBR) from MR_FDG images was significantly higher compared with SUV images (2.6 ± 0.8 vs 1.4 ± 0.2; P < 0.0001), confirming improved arterial wall contrast. On MR_FDG images, arterial wall signal showed improved correlation with hematopoietic and lymphoid organ activity (spleen P = 0.0009; lymph nodes P = 0.0055; and bone marrow P = 0.0202) and increased with the number of atherosclerotic risk factors (r = 0.49; P = 0.0138), where signal from SUV images (SUV_maxP = 0.9754; TBR_maxP = 0.8760) did not.

Conclusions: Absolute quantification of MR_FDG is feasible for arterial wall using dynamic whole-body PET imaging. Parametric images provide superior arterial wall contrast, and they might be better suited to explore the relationship between arterial wall activity, systemic organ networks, and cardiovascular risk. This novel methodology may serve as a platform for future diagnostic and therapeutic clinical studies targeting the biology of arterial wall disease.

Keywords: Patlak graphical analysis; atherosclerosis; parametric imaging; positron emission tomography; whole-body imaging.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Kinetics
Positron-Emission Tomography*
Predictive Value of Tests