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Vöö S, Kwee RM, Sluimer JC, Schreuder FHBM, Wierts R, Bauwens M, Heeneman S, Cleutjens JPM, van Oostenbrugge RJ, Daemen JWH, Daemen MJAP, Mottaghy FM, Kooi ME. Imaging Intraplaque Inflammation in Carotid Atherosclerosis With 18F-Fluorocholine Positron Emission Tomography-Computed Tomography: Prospective Study on Vulnerable Atheroma With Immunohistochemical Validation. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004467. [PMID: 27162131 DOI: 10.1161/circimaging.115.004467] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/17/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND (18)F-fluorocholine ((18)F-FCH) uptake is associated with cell proliferation and activity in tumor patients. We hypothesized that (18)F-FCH could similarly be a valuable imaging tool to identify vulnerable plaques and associated intraplaque inflammation and atheroma cell proliferation. METHODS AND RESULTS Ten consecutive stroke patients (90% men, median age 66.5 years, range, 59.4-69.7) with ipsilateral >70% carotid artery stenosis and who underwent carotid endarterectomy were included in the study. Before carotid endarterectomy, all patients underwent positron emission tomography to assess maximum (18)F-FCH uptake in ipsilateral symptomatic carotid plaques and contralateral asymptomatic carotid arteries, which was corrected for background activity, resulting in a maximum target-to-background ratio (TBRmax). Macrophage content was assessed in all carotid endarterectomy specimens as a percentage of CD68(+)-staining per whole plaque area (plaqueCD68(+)) and as a maximum CD68(+) percentage (maxCD68(+)) in the most inflamed section/plaque. Dynamic positron emission tomography imaging demonstrated that an interval of 10 minutes between (18)F-FCH injection and positron emission tomography acquisition is appropriate for carotid plaque imaging. TBRmax in ipsilateral symptomatic carotid plaques correlated significantly with plaqueCD68(+) (Spearman's ρ=0.648, P=0.043) and maxCD68(+) (ρ=0.721, P=0.019) in the 10 corresponding carotid endarterectomy specimens. TBRmax was significantly higher (P=0.047) in ipsilateral symptomatic carotid plaques (median: 2.0; interquartile range [Q1-Q3], 1.5-2.5) compared with the contralateral asymptomatic carotid arteries (median: 1.4; Q1-Q3, 1.3-1.6). TBRmax was not significantly correlated to carotid artery stenosis (ρ=0.506, P=0.135). CONCLUSIONS In vivo uptake of (18)F-FCH in human carotid atherosclerotic plaques correlated strongly with degree of macrophage infiltration and recent symptoms, thus (18)F-FCH positron emission tomography is a promising tool for the evaluation of vulnerable plaques. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01899014.
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Affiliation(s)
- Stefan Vöö
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Robert M Kwee
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Judith C Sluimer
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Floris H B M Schreuder
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Roel Wierts
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Matthias Bauwens
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Sylvia Heeneman
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Jack P M Cleutjens
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Robert J van Oostenbrugge
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Jan-Willem H Daemen
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Mat J A P Daemen
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.)
| | - Felix M Mottaghy
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.).
| | - M Eline Kooi
- From the CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (S.V., J.C.S., F.H.B.M.S., S.H., R.J.v.O., M.E.K.); Departments of Radiology and Nuclear Medicine (S.V., R.M.K., F.H.B.M.S., R.W., M.B., F.M.M., M.E.K.), Pathology (J.C.S., S.H., J.P.M.C.), Neurology (F.H.B.M.S., R.J.v.O.), and Surgery (J.-W.H.D.), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.A.P.D.); and Department of Nuclear Medicine, University Hospital, RWTH Aachen University, Aachen, Germany (F.M.M.).
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