The recently published article in the Journal of the Neurological Sciences by Kim et al., titled ‘Carotid inflammation on 18F-fluorodeoxyglucose positron emission tomography associates with recurrent ischemic
lesions’, was very interesting [
[1]
]. In this retrospective, case–control study, the authors analyzed prospectively collected
data from 21 patients with symptomatic extracranial carotid atherosclerotic disease
(ECAD) for an association between 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) and the presence
of clinically silent, early recurrent ischemic lesions (ERIL), as defined by diffusion-weighted
magnetic resonance imaging (DWI). The mean patient age was 66.3 years, and the median degree of carotid stenosis was 81% (range 46–93%). ERILs were
detected in eight patients (38%) on DWI, performed at median of 1.4 days after stroke onset, including six patients with ipsilateral ERILs (29%) and two
patients with bilateral ERILs (10%). The median number of ERILs per patient was 7.5
(range 2–21). FDG uptake, as measured by maximum standardized uptake was significantly
higher in patients with ERILs compared to those without ERILs (mean 3.07 vs. 2.17,
respectively; p = 0.013). Additionally, there was a trend toward higher FDG uptake in patients with
irregular plaques, as assessed by carotid ultrasonography (p = 0.097). Given that the only widely utilized angiographic metric for guiding intervention
for ECAD is the severity of stenosis, this study suggests that additional approaches
of plaque assessment, such as FDG PET, may provide useful, supplementary data for
predicting the clinical and radiologic behavior of carotid plaques. In the following
discussion, our goals are to (1) briefly review the role of inflammation in the pathogenesis
of atherosclerosis and (2) analyze the efficacy of currently available imaging methods
for the evaluation of plaque stability in ECAD.Keywords
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References
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- Carotid plaque inflammation on 18F-fluorodeoxyglucose positron emission tomography predicts early stroke recurrence.Ann Neurol. 2012; 71: 709-718
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Article info
Publication history
Published online: January 16, 2015
Accepted:
January 11,
2015
Received in revised form:
January 8,
2015
Received:
December 10,
2014
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
