Comparison of atherosclerotic inflammation and calcification in subjects with end stage renal disease (ESRD) on hemodialysis, to normal controls utilizing FDG-PET/CT

• Published in: The Journal of nuclear medicine (1978) Vol. 59; p. 1553
• Main Authors: Bural, Gonca, Torigian, Drew, Sözmen, Melih, Houseni, Mohamed, Alavi, Abass
• Format: Journal Article
• Language: English
• Published: New York Society of Nuclear Medicine 01.05.2018
• Subjects: Aorta; Aortic arch; Arteries; Arteriosclerosis; Atherosclerosis; Calcification; Calcification (ectopic); Cardiovascular disease; Cardiovascular diseases; Chi-square test; Computed tomography; Continuity (mathematics); Coronary vessels; Diagnostic software; Diagnostic systems; Dialysis; Disease control; Femoral artery; Femur; Hemodialysis; Inflammation; Kidney diseases; Morbidity; Mortality; Positron emission; Positron emission tomography; Qualitative analysis; Segments; Statistical analysis; Statistical tests; Tomography; Veins & arteries
• ISSN: 0161-5505; 1535-5667

Introduction: Atherosclerosis is a cardiovascular disease involving all arterial beds, marked by inflammation and calcification. It stil remains as the leading cause of mortality worldwide.18F-FDG-PET/CT is a reliable diagnostic tool for the detection and quantification of atherosclerotic inflammation using standardized uptake value (SUV) measurements. Determination of macroscopic atherosclerotic calcification is also feasible via the CT portion of PET/CT. Subjects with end stage renal disease are exposed to increased morbidity and mortality due to cardiovascular events. The primary underlying mechanism has been suggested as the accelerated atherosclerosis in these patients. Our aim was to compare the atherosclerotic inflammation and calcification in subjects with end stage renal disease (ESRD) on hemodialysis to that in normal controls utilizing FDG-PET/CT. Methods: 42 subjects who underwent FDG-PET/CT imaging were retrospectively studied. Twenty one were subjects with ESRD on hemodialysis (67±11years old; 14 male, 7 female), and 21 were age and gender matched controls (67±11years old; 14 male, 7 female). Average SUVmax and SUVmean for four segments of the aorta (ascending, arch, descending, abdominal) and for the common iliac arteries and common femoral arteries were measured. SUVmax and SUVmean for right atrial blood pool was also measured as the background. Average SUVmax and SUVmean for all segments, and average SUVmax/background ratios and average SUVmean/background ratios for all segments were compared between subject groups. Presence or absence of macroscopic calcification on CT images for each arterial segment based on visual qualitative assessment was also noted and compared. For statistical analysis, t-test was used for continuous variables, and chi-square test was used for categorical variables. We considered a p value of <0.05 as statistically significant. Results: Average SUVmax and SUVmean were statistically significantly greater in subjects with ESRD than in controls in all arterial segments. Average SUVmax/background ratios were statistically significantly greater in subjects with ESRD compared to normal controls in all arterial segments except for the left femoral artery. Average SUVmean/background ratios were statistically significantly greater in subjects with ESRD compared to normal controls in all arterial segments except for the right and left femoral arteries. Presence of calcification on CT was more frequently encountered in all arterial segments in subjects with ESRD, but was statistically significantly greater for the aortic arch, descending aorta, and right and left femoral arteries. Conclusions: Our data suggest that SUV measurements representing the atherosclerotic inflammatory changes and macroscopic atherosclerotic calcifications appear to be accelerated in subjects with ESRD on hemodialysis compared to normal controls. FDG-PET/CT is a valuable diagnostic tool for verifying and quantifying accelerated atherosclerosis secondary to ESRD.