PET-Based Imaging with 18F-FDG and 18F-NaF to Assess Inflammation and Microcalcification in Atherosclerosis and Other Vascular and Thrombotic Disorders

Figures

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  Figure 1. FDG-PET images illustrating the foci of FDG uptake along the aorta. In the sagittal view, the arrow in the left image indicates the abdominal aorta, while the top arrow on the right points to the budding superior mesenteric artery. In the transverse view, the bottom and top arrows indicate the abdominal aorta and budding superior mesenteric artery, respectively. In the coronal view, the arrow points to the budding mesenteric artery. In the CT image, the left arrow points to calcification along the abdominal aorta, while the right indicates to the budding superior mesenteric artery (from Yun et al. [23] with permission).

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  Figure 2. CT, NaF-PET, and fused NaF-PET/CT images of clinically normal (a) 25- and (b) 61-year -old subjects’ hearts. Green line delineates the region of interest around the heart analyzed to calculate the global cardiac calcification scores, which are 12,492.44 (a) and 18,424.70 (b). Despite the relatively increased NaF uptake in the PET scan of the subject’s heart (b), there is no visible calcification in the corresponding CT scan. The disparity between two modalities alludes to CT-visible macrocalcification as end-stage disease process, while NaF uptake may reflect early pathological, molecular changes (from Raynor et al. [94] with permission).

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  Figure 3. Schematic illustration of the stages of atherosclerosis in the coronary arteries. Uptake of both FDG and NaF is evident before the structural changes are visible, but inflammation and FDG uptake does not necessarily precede microcalcification. Thus, NaF uptake may be present earlier than previously thought (red arrow).

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  Figure 4. CT (a) and the corresponding FDG-PET (b) images of a 75-year-old woman with a history of melanoma. The white arrows point to pulmonary embolism (PE) present in the right lower lobe segmental artery. Increased FDG uptake (b) is seen at the location of PE on the PET image (from Flavell et al. [119] with permission).

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  Figure 5. FDG-PET images of a 78-year-old woman with giant cell arteritis at the baseline (a), 3 months of therapy (b), and 6 months of therapy (c). High-tracer uptake is initially present and visible in the thoracic aorta and subclavian arteries, as evident in the first two images from the left (a), which progressively decreased after treatment with steroids (from Blockmans et al. [142] with permission).