Background:Inflammation and microcalcification are interrelated processes contributing to atherosclerotic plaque vulnerability. Positron-emission tomography can quantify these processes in vivo. This study investigates (1) ¹⁸F-fluorodeoxyglucose (FDG) and ¹⁸F-sodium fluoride (NaF) uptake in culprit versus nonculprit carotid atheroma, (2) spatial distributions of uptake, and (3) how macrocalcification affects this relationship.Methods:Individuals with acute ischemic stroke with ipsilateral carotid stenosis of ≥50% underwent FDG-positron-emission tomography and NaF-positron-emission tomography. Tracer uptake was quantified using maximum tissue-to-background ratios (TBR_max) and macrocalcification quantified using Agatston scoring.Results:In 26 individuals, median most diseased segment TBR_max (interquartile range) was higher in culprit than in nonculprit atheroma for both FDG (2.08 [0.52] versus 1.89 [0.40]; P<0.001) and NaF (2.68 [0.63] versus 2.39 [1.02]; P<0.001). However, whole vessel TBR_max was higher in culprit arteries for FDG (1.92 [0.41] versus 1.71 [0.31]; P<0.001) but not NaF (1.85 [0.28] versus 1.79 [0.60]; P=0.10). NaF uptake was concentrated at carotid bifurcations, while FDG was distributed evenly throughout arteries. Correlations between FDG and NaF TBR_max differed between bifurcations with low macrocalcification (r_s=0.38; P<0.001) versus high macrocalcification (r_s=0.59; P<0.001).Conclusions:This is the first study to demonstrate increased uptake of both FDG and NaF in culprit carotid plaques, with discrete distributions of pathophysiology influencing vulnerability in vivo. These findings have implications for our understanding of the natural history of the disease and for the clinical assessment and management of carotid atherosclerosis.

中文翻译：

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双轨正电子发射断层扫描，用于识别颈动脉颈动脉斑块和体内病理生理学。

背景：炎症和微钙化是相互关联的过程，有助于动脉粥样硬化斑块的脆弱性。正电子发射断层扫描可以量化体内这些过程。这项研究调查（1）罪犯与非罪犯颈动脉粥样硬化的¹⁸ F-氟脱氧葡萄糖（FDG）和¹⁸ F-氟化钠（NaF）摄取，（2）摄取的空间分布以及（3）宏观钙化如何影响这种关系。患有同侧颈动脉狭窄≥50％的急性缺血性卒中患者，进行FDG-正电子发射断层扫描和NaF-正电子发射断层扫描。使用最大组织与背景之比（TBR_最大结果：在26个个体中，FDG的罪魁祸首中，大多数患病段的TBR _max（四分位间距）中位数高于非罪魁祸首（2.08 [0.52]对1.89 [0.40]；P <0.001） NaF（2.68 [0.63]对2.39 [1.02]；P <0.001）。然而，FDG的罪魁祸首全血管TBR _max较高（1.92 [0.41]对1.71 [0.31]；P <0.001），而不是NaF（1.85 [0.28]对1.79 [0.60]；P = 0.10）。NaF的摄取集中在颈动脉分叉处，而FDG则平均分布在整个动脉中。FDG与NaF TBR _max之间的相关性低钙化（r _s = 0.38; P <0.001）与高钙化（r _s = 0.59; P <0.001）的分叉之间有差异。结论：这是第一项研究表明在颈总动脉斑块中FDG和NaF摄取增加。 ，病理生理的离散分布会影响体内的脆弱性。这些发现对我们对疾病自然史的理解以及对颈动脉粥样硬化的临床评估和管理具有重要意义。