Validation of FDG uptake in the arterial wall as an imaging biomarker of atherosclerotic plaques with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT)

J Neuroimaging. Mar-Apr 2014;24(2):117-23. doi: 10.1111/j.1552-6569.2012.00740.x. Epub 2012 Aug 28.


Background and purpose: From the literature, the prevalence of fluorodeoxyglucose (FDG) uptake in large artery atherosclerotic plaques shows great heterogeneity. We retrospectively reviewed 100 consecutive patients who underwent FDG-positron emission tomography-computed tomography (PET/CT) imaging of their whole body, to evaluate FDG uptake in the arterial wall.

Materials and methods: We retrospectively evaluated 100 whole-body PET-CT scans. The PET images coregistered with CT were reviewed for abnormal 18F-FDG uptake. The mean standard uptake value (SUV) was measured in regions of interest (ROIs). The prevalence of PET+ plaques was determined based on the qualitative PET review, used as the gold standard in a receiver-operating characteristic (ROC) curve analysis to determine an optimal threshold for the quantitative PET analysis.

Results: The qualitative, visual assessment demonstrated FDG uptake in the arterial walls of 26 patients. A total of 85 slices exhibited FDG uptake within the arterial wall of 37 artery locations. 11, 17, and 2 patients exhibited FDG uptake within the wall of carotid arteries, of the aorta, and of the iliac arteries, respectively. Only 4 of the 26 patients had positive FDG uptake in more than one artery location. In terms of quantitative analysis, a threshold of 2.8 SUV was associated with a negative predictive value of 99.4% and a positive predictive value of 100% to predict qualitative PET+ plaques. A threshold of 1.8 SUV was associated with a negative predictive value of 100% and a positive predictive value of 99.4%. Area under the ROC curve was .839.

Conclusion: The prevalence of PET uptake in arterial walls in a consecutive population of asymptomatic patients is low and usually confined to one type of artery, and its clinical relevance in terms of vulnerability to ischemic events remains to be determined.

Keywords: Atherosclerotic plaques; computed tomography; positron emission tomography.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Angiography / methods
  • Arteries / diagnostic imaging
  • Arteries / metabolism
  • Atherosclerosis / diagnosis*
  • Atherosclerosis / metabolism*
  • Biomarkers / metabolism
  • Female
  • Fluorodeoxyglucose F18 / pharmacokinetics*
  • Humans
  • Image Interpretation, Computer-Assisted / methods
  • Male
  • Metabolic Clearance Rate
  • Middle Aged
  • Models, Biological
  • Multimodal Imaging / methods*
  • Positron-Emission Tomography / methods*
  • Radiopharmaceuticals / pharmacokinetics
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tissue Distribution
  • Tomography, X-Ray Computed / methods*
  • Whole Body Imaging / methods


  • Biomarkers
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18