Gethin Williams MD,PhD, Presenter: Nothing to Disclose

Gerald Mordecai Kolodny MD, Abstract Co-Author: Nothing to Disclose

PURPOSE: F18-FDG-PET accurately detects inflammation associated with active plaque formation in the aorta and carotid arteries. Investigation of coronary artery active plaque formation using FDG-PET has been limited by the high F18-FDG uptake of the myocardium. We recently developed a patient preparation protocol (SNM, 2006) using a high fat/no carbohydrate meal 3 hours before a FDG-PET scan, which significantly reduces background cardiac FDG uptake. We aimed to determine whether focal FDG uptake could be detected along the course of coronary arteries in patients with known CAD, who were prepared with this new protocol.

Fifty eight FDG-PET/CT studies performed for non-cardiac indications were reviewed and coronary artery calcification (CAC) and focal coronary artery FDG (CA-FDG) uptake determined. Cardiac histories were obtained. Age range 21-88y (63±16y); 35 women/23 men; 6 had CAD documented by myocardial perfusion imaging, cardiac catheterization, or history of PCI or CABG. χ² probabilities were calculated.

Fourteen of the 58 patients studied showed focal CA-FDG uptake. Thirteen of these had CAC; FDG uptake correlated with CAC (χ² p = 0.001); 4 of 6 with documented CAD had focal CA-FDG. In this population, using cardiac history as the standard, the sensitivity and specificity of focal CA-FDG uptake to predict CAD were 67 & 81% respectively. However, not all patients with chronic CAD would be expected to always have foci of active plaque formation. This probably contributes to lowering the sensitivity and specificity using CAD as the standard. Although there is significant cardiac motion during PET scanning due to cardiac contraction and respiratory motion, this motion did not appear to significantly alter the focal nature of the observed uptake, possibly because of the relative length of diastole and end respiratory expiration.

With proper patient preparation to reduce high FDG uptake by the myocardium, FDG-PET/CT may offer a method to detect the inflammation associated with biologically active plaque formation in CAD.

F18-FDG-PET/CT may be useful to detect CAD and localize sites of active coronary plaque formation.

Williams, G, Kolodny, G, A Method for Detecting Biological Active Coronary Artery Disease (CAD) by F18-Fluorodeoxyglucose (FDG): Positron Emission Tomography (PET)/Computed Tomography (CT).  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4431039.html