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Stroke. 2013 Dec;44(12):3568-70. doi: 10.1161/STROKEAHA.113.003140. Epub 2013 Oct 10.

Combined 18F-FDG PET-CT and DCE-MRI to assess inflammation and microvascularization in atherosclerotic plaques.

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  • 1From the Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (M.T.B.T., R.H.M.v.H., E.H., R.J.v.O., J.B., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., R.M.K., R.H.M.v.H., E.H., W.H.B., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., W.H.M.), Neurology (R.J.v.O.), Nuclear Medicine (J.B.), Maastricht University Medical Center, Maastricht, The Netherlands; and Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (M.J.D.).



Hallmarks of vulnerable atherosclerotic plaques are inflammation that can be assessed with 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography, and increased neovascularization that can be evaluated by dynamic contrast-enhanced-MRI. It remains unclear whether these parameters are correlated or represent independent imaging parameters. This study determines whether there is a correlation between inflammation and neovascularization in atherosclerotic carotid plaques.


A total of 58 patients with transient ischemic attack or minor stroke in the carotid territory and ipsilateral carotid artery stenosis of 30% to 69% were included. All patients underwent positron emission tomography/computed tomography and dynamic contrast-enhanced-MRI of the carotid plaque. 18Fluorine-fluorodeoxyglucose standard uptake values with target/background ratio were determined. Neovascularization was quantified by the mean (leakage) volume transfer constant Ktrans. Spearman rank correlation coefficients between target/background ratio and Ktrans were calculated.


Images suitable for further analysis were obtained in 49 patients. A weak but significant positive correlation between target/background ratio and mean Ktrans (Spearman ρ=0.30 [P=0.035]) and 75th percentile Ktrans (Spearman ρ=0.29 [P=0.041]) was found.


There is a weak but significant positive correlation between inflammation on positron emission tomography/computed tomography and neovascularization as assessed with dynamic contrast-enhanced-MRI. Future studies should investigate which imaging modality has the highest predictive value for recurrent stroke, as these are not interchangeable.

CLINICAL TRIAL REGISTRATION URL: Unique identifier: NCT00451529.


atherosclerosis; imaging; inflammation; magnetic resonance imaging; neovascularization; plaque, atherosclerotic; positron-emission tomography; vascular diseases

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