Carotid plaque imaging with SPECT/CT and PET/CT

Abstract

A major contributor to the occurrence of ischaemic stoke is the existence of carotid atherosclerosis. A vulnerable carotid atherosclerotic plaque may rupture or erode, thus causing a thrombotic effect. Currently, clinical decision making with regard to carotid endarterectomy or stenting is still primarily based on the extent of luminal stenosis, estimated with CT angiography and/or (duplex) ultrasonography. However, there is growing evidence that the anatomic impact of stenosis alone has limited value in predicting the exact consequences of plaque vulnerability. Various molecular processes have, independently of degree of stenosis, shown to be importantly associated with the plaque’s capability to cause thrombotic events. These molecular processes can be visualised with nuclear medicine techniques allowing the identifi cation of vulnerable patients by noninvasive in vivo SPECT(/CT) and PET(/CT) imaging. This chapter provides an overview of SPECT(/CT) and PET(/CT) imaging with specifi c radiotracers that have been evaluated for the detection of plaques together with a future perspective in this fi eld of imaging.