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 [
]. 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.
- Kim H.J.
- Oh M.
- Moon D.H.
- Yu K.H.
- Kwon S.U.
- Kim J.S.
- et al.
Carotid inflammation on F-fluorodeoxyglucose positron emission tomography associates with recurrent ischemic lesions.
J Neurol Sci. 2014; 347: 242-245
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- Carotid inflammation on F-fluorodeoxyglucose positron emission tomography associates with recurrent ischemic lesions.J Neurol Sci. 2014; 347: 242-245
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Published online: January 16, 2015
Accepted: January 11, 2015
Received in revised form: January 8, 2015
Received: December 10, 2014
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.