방사선의학 웹진

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그림설명) 57세 남성으로 건강검진 목적으로 FDG PET/CT를 시행하였다. 경동맥에서 FDG 섭취증가가 나타나는 것을 볼 수 있다(화살표). 이 남성은 고혈압과 당뇨를 가지고 있었으나 약물치료로 조절 중이었고 심혈관 질환과 연관된 증상은 없었다. 운동부하 심초음파에서는 정상 이었으며 그 외에 다른 유의한 질환은 없었다. 1FDG PET/CT 1개월 후 시행한 심혈관조영술에서 협심증을 진단 받았고 4개월 후 관상동맥중재술을 시행 받았다.

Abstract

OBJECTIVES:

This study sought to investigate the role of carotid fluoro-2-deoxyglucose (FDG) uptake as an independent prognostic indicator and to determine whether its addition improves risk prediction beyond the Framingham risk score (FRS) and carotid intima-media thickness (CIMT).

BACKGROUND:

The prognostic value of carotid FDG uptake independent of and incremental to traditional cardiovascular risk factors and CIMT in asymptomatic individuals has not been evaluated.

METHODS:

We measured carotid FDG uptake and CIMT in 1,089 asymptomatic adults (51.8 ± 6.3 years of age, 94.3% males) who underwent positron emission tomography/computed tomography imaging and examined the prognostic value of carotid FDG uptake compared with traditional risk factors and CIMT.

RESULTS:

Cardiocerebrovascular events occurred in 19 participants (1.74%) during an average follow-up of 4.2 years (range 1.0 to 5.5 years). Multivariable Cox proportional hazards analyses revealed that high carotid FDG uptake (hazard ratio: 2.98; 95% confidence interval: 1.17 to 7.62; p = 0.022) and high CIMT (hazard ratio: 2.82; 95% confidence interval: 1.13 to 7.03; p = 0.026) were independent predictors of events. Comparison of predictive power demonstrated that adding carotid FDG uptake, but not CIMT, to the FRS significantly increased the time-dependent area under the receiver-operating characteristic curve from 0.60 to 0.73 (p = 0.04). Furthermore, improvement approaching significance was achieved by adding carotid FDG uptake to the FRS plus CIMT, which increased the area under the receiver-operating characteristic curve from 0.65 to 0.75 (p = 0.07). Net reclassification for event prediction was similarly improved by addition of carotid FDG uptake to the FRS (net reclassification index, 40.1%; p = 0.06), as well as the FRS plus CIMT (net reclassification index, 32.9%; p = 0.07).

CONCLUSIONS:

High carotid FDG uptake predicts cardiovascular events independent of traditional risk factors and CIMT in asymptomatic adults and may add to risk stratification beyond the FRS and CIMT.

Author information

Moon SH1, Cho YS1, Noh TS1, Choi JY1, Kim BT1, Lee KH2.

1Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
2Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: khnm.lee@samsung.com.

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