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Fluorodeoxyglucose Uptake in the Aortic Wall at PET/CT: Possible Finding for Active Atherosclerosis¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine, Johns Hopkins Medical Institutions, 601 N Caroline St, Rm 3223A, Baltimore, MD 21287-0817. Received September 13, 2002; revision requested November 20; final revision received May 15, 2003; accepted May 20. Address correspondence to R.L.W. (e-mail: rwahl@jhmi.edu).

PURPOSE: To evaluate fluorine 18 fluorodeoxyglucose (FDG) uptake in the thoracic aortic wall at combined positron emission tomography (PET)/computed tomography (CT) and compare uptake with aortic wall calcification.

MATERIALS AND METHODS: Records of 85 consecutive cancer patients who underwent FDG PET/CT were evaluated retrospectively. One hour after FDG injection, CT followed by PET was performed from ear to middle of the thigh. CT, PET, and fused PET/CT images were generated. FDG uptake and calcification were evaluated visually and semiquantitatively. FDG uptake was graded according to intensity; calcification, according to thickness. Unpaired t test was used for comparison of patient age with and without FDG uptake and with and without calcification. The relationship between the score (sum of grades along all aortic segments) of positive FDG uptake and calcification and patient age was analyzed with Spearman rank correlation. Comparison of frequency of FDG uptake and calcification with age, sex, risk factors for cardiovascular disease (CVD), or history of CVD was performed with ² analysis.

RESULTS: Fifty patients had at least one area of FDG uptake in thoracic aortic wall, 14 of whom showed focal FDG uptake. Intermediate to intense FDG uptake tended to be observed in the descending aorta. Forty-five patients had at least one measurable aortic calcification. Thick calcification was observed most often at the aortic arch. Twelve patients had 13 uptake areas at the calcification site. Patients with positive findings were on average older (P < .05 for both increased uptake and calcification); the older patient group had higher frequency of both aortic wall uptake (P < .005) and calcification (P < .001). The calcification score correlated with age ( = 0.60, P < .001) but the FDG uptake score did not. Women, patients with hyperlipidemia, and patients with history of CVD tended to show increased FDG uptake (P = .073, .080, and .068, respectively), whereas patients with diabetes had significantly more calcifications (P < .05).

CONCLUSION: PET/CT depicted FDG uptake commonly in the thoracic aortic wall. The FDG uptake site was mostly distinct from the calcification site and may possibly be located in areas of metabolic activity of atherosclerotic changes.

© RSNA, 2003

Index terms: Aorta, CT, 56.12111, 94.12911 • Aorta, diseases, 56.754 • Arteries, calcification, 56.812 • Dual-modality imaging, PET/CT • Images, fusion • Positron emission tomography (PET), 56.12163, 94.12963

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