Imaging Intraplaque Inflammation in Carotid Atherosclerosis With F-18-Fluorocholine Positron Emission Tomography-Computed Tomography Prospective Study on Vulnerable Atheroma With Immunohistochemical Validation

Stefan Vöö, Robert M. Kwee, Judith C. Sluimer, Floris H. B. M. Schreuder, Roel Wierts, Matthias Bauwens, Sylvia Heeneman, Jack P. M. Cleutjens, Robert J. van Oostenbrugge, Jan-Willem H. Daemen, Mat J. A. P. Daemen, Felix M. Mottaghy*, Eline Kooi*

*Corresponding author for this work

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Background-F-18-fluorocholine (F-18-FCH) uptake is associated with cell proliferation and activity in tumor patients. We hypothesized that F-18-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 F-18-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 F-18-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 rho=0.648, P=0.043) and maxCD68(+) (rho=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 (rho=0.506, P=0.135). Conclusions-In vivo uptake of F-18-FCH in human carotid atherosclerotic plaques correlated strongly with degree of macrophage infiltration and recent symptoms, thus F-18-FCH positron emission tomography is a promising tool for the evaluation of vulnerable plaques.
Original languageEnglish
Article numbere004467
JournalCirculation-Cardiovascular Imaging
Issue number5
Publication statusPublished - May 2016


  • atherosclerosis
  • carotid artery diseases
  • endarterectomy
  • fluorocholine
  • inflammation
  • macrophages
  • positron-emission tomography

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