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22. European Stroke Conference 3 Vascular imaging 8:50 - 9:00 Usefulness of PET-CT in the diagnosis of patients with “vulnerable” carotid plaques: cor-relation to clinical symptoms, to the presence of micro-embolic signals and to plasmatic markers of inflammation H.F.G. Mueller1, L. Fisch2, C. Bonvin3, K. Lovblad4, O. Ratib5, P. Lalive6, J.P. Willi7, R. Szta-jzel8 Hopitaux Universitaires de Geneve (HUG), Geneva, SWITZERLAND1,HUG, Geneva, SWITZERLAND2, HUG, Geneva, SWITZERLAND3, HUG, Geneva, SWITZERLAND4, HUG, Geneva, SWITZERLAND5, HUG, Geneva, SWITZERLAND6, HUG, Geneva, SWIT-ZERLAND7, HUG, Geneva, SWITZERLAND8 Background Vulnerable atherosclerotic plaques responsible for ischemic stroke are characterized by high numbers of inflammatory cells and proteins. The glucose analogue 18F-fluorodeoxyglucose (FDG) can be used to image inflammatory cell activity by positron emission tomography (PET-CT). The aim of our study was to evaluate whether PET-CT showed a higher accumulation of FDG in symptomatic plaques and those generating micro-embolic signals (MES+). Further-more we investigated whether inflammatory plasmatic biomarkers also correlated with the dif-ferent clinical and imaging parameters. Patients and methods Patients with 50 to 99% symptomatic or asymptomatic carotid disease were included. FDG-PET- CT was performed within 3 days after symptoms onset. MES detection by transcranial Doppler was carried out for 60’. Further workup included blood samples for analysis of inflam-matory parameters (MMP-9,-8 and others). Analysis of PET-CT included mean and maximum standardized uptake values (SUV) of the carotid plaque, bilateral common carotid arteries and jugular veins. The uptake was calculated by the delta of maximal SUV of the plaque and aver-age SUV of the jugular veins. Results 123 carotid plaques were analyzed, 61 symptomatic and 62 asymptomatic. The SUV uptake was significantly higher in symptomatic (p=0.02) and in MES+ ( p=0.004) plaques. Analysis of biomarkers performed in 80 patients further showed a significant correlation between clinical symptoms, MMP-9 (p=0.02) and MMP-8 (p=0.02). In a logistical regression analysis includ-ing the following variables (age, degree of stenosis, MMP-9, uptake, MES+, Hounsfield units), MMP-9 (p=0.01) and PET uptake (p=0.02) turned out to be independent predictors of the pres-ence of symptoms (sensitivity/specificity: 80/53%, AUC 0.733). Conclusions FDG-PET-CT and MMP-9 had the potential to identify vulnerable and symptomatic plaques and may therefore improve our selection criteria for carotid surgery or stenting. 182 © 2013 S. Karger AG, Basel Scientific Programme


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