Effects of coverage extent and slice skipping on mean and maximum arterial 18 F-FDG uptake ratios in patients with carot
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ORIGINAL ARTICLE
Effects of coverage extent and slice skipping on mean and maximum arterial 18F-FDG uptake ratios in patients with carotid plaque Tae-Soo Noh • Jang Yoo • Se Won Kim Eun Jeong Lee • Joon Young Choi • Byung-Tae Kim • Kyung-Han Lee
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Received: 7 May 2012 / Accepted: 1 July 2012 / Published online: 17 July 2012 Ó The Japanese Society of Nuclear Medicine 2012
Abstract Purpose To investigate the effects of variable measurement methods on mean and maximum SUV ratios of 18FFDG uptake in carotid arteries. Methods 18F-FDG PET/CT images of 74 subjects with carotid plaque were analyzed for mean and maximum target-to-background ratio (TBR) of uptake. Agreement was analyzed between TBR scores obtained using different vessel coverage and slice skipping. Results Mean TBR was increased by extending coverage from common carotid artery (CCA; 1.25) to carotid artery (CA; 1.33) and inclusion of ascending aorta (CA/AA; 1.34). Maximum TBR was increased from 1.47 to 1.54 and 1.61 by respective extensions. Both mean and maximum TBR were closely correlated between vessels. ICC and Kappa statistics revealed near perfect agreement between TBR obtained using every 2 or 3 segments and that without sipping. Bland–Altman plots showed bias by slice skipping to remain small, particularly for mean TBR. Finally, high correlations were displayed between mean and maximum TBR. Conclusions Analysis of mean and maximum arterial 18 F-FDG uptake in patients with carotid plaque is likely to benefit from extending coverage to segments above and below the CCA. The extra burden of measurement, in turn,
T.-S. Noh J. Yoo E. J. Lee J. Y. Choi B.-T. Kim K.-H. Lee (&) Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea e-mail: [email protected] S. W. Kim Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
can be lightened by skipping up to every 2 of 3 slices without compromising accuracy of results. Keywords PET/CT 18F-FDG Atherosclerosis Carotid artery Uptake ratio
Introduction Given the prevalence and severity of stroke disease, identifying patients who are at risk is an important health concern [1]. It is now evident that, in addition to the presence of carotid artery stenosis, plaque composition and biologic activity beyond luminal encroachment contribute significantly to the risk of cerebrovascular events [1, 2]. As such, the ability to image plaque characteristics could provide information useful for ascribing the most appropriate therapy for patients with carotid atherosclerosis [3]. 18 F-FDG PET offers non-invasive monitoring of plaque inflammation, a characteristic that stands-out in its association with future risk of ischemic stroke [4]. Increased arterial 18F-FDG uptake has been shown to correlate with clinical atherosclerotic risk factors [5–7] in a manner that is reversed by plaque inflammation reducing treatments [8– 10]. Furthermore, studies indicate a link bet
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