Hybrid positron emission tomography and magnetic resonance imaging in carotid atherosclerosis: Not ready for prime time?
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Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland Swiss Paraplegic Center, Nottwil, Switzerland
Received Oct 16, 2020; accepted Oct 16, 2020 doi:10.1007/s12350-020-02426-4
See related article, https://doi.org/10.10 07/s12350-020-02400-0. Carotid atherosclerosis remains a major cause of cerebrovascular insults.1,2 Although anatomical assessment of luminal narrowing is frequently performed in clinical routine, it does not reliably identify high-risk culprit lesions that are characterized by morphological features such as a thin fibrous cap, a large lipid-rich necrotic core, neovascularization, and intraplaque hemorrhage.3 Given the high spatial resolution of magnetic resonance imaging (MRI), which provides an excellent soft tissue contrast, MRI is perfectly suited to assess the abovementioned morphological carotid plaque features.4 Nonetheless, culprit lesions are not only characterized by a detrimental morphology, but are frequently accompanied by active inflammation and microcalcification processes.5 As such, functional imaging with positron emission tomography (PET) has tackled a
Funding CG was supported by grants from the Swiss National Science Foundation (SNSF), the Olga Mayenfisch Foundation, Switzerland, the OPO Foundation, Switzerland, the Novartis Foundation, Switzerland, the Swissheart Foundation, the Helmut Horten Foundation, Switzerland, the EMDO Foundation, the Iten-Kohaut Foundation, Switzerland, the University Hospital Zurich Foundation, and the LOOP, Zurich. AH was supported by the University of Zurich (UZH) Foundation. MF was supported by the Swiss Paraplegic Center. SB was supported by the Swissheart Foundation and the UZH Foundation. Reprint requests: Michael Fiechter, MD, PhD, Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
longstanding issue by providing a highly sensitive and non-invasive detection method for activated macrophages, which constitute a hallmark of atherosclerosis.6 PET tracers that have been harnessed for vascular macrophage imaging mainly include 18F-fluorodeoxyglucose (18F-FDG), somatostatin receptortargeted and translocator protein (TSPO)-directed probes.6 Further, microcalcification processes can be visualized by 18F-sodium fluoride (18F-NaF) PET due to the inherent ability of fluoride ions to react with hydroxyapatite crystals.7 Considering the complementing properties of PET and MRI, it is not surprising that hybrid PET/MRI systems have been developed and recently introduced to nuclear medicine facilities—with high expectations. In this issue of the Journal of Nuclear Cardiology, Mechtouff et al. report on an exploratory study assessing the potential of hybrid PET/MRI with 18F-NaF to provide information on plaque morphology and the extent of microcalcification in the carotid arteries. The authors included a total of
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