18F-FDG Uptake on PET/CT in Symptomatic versus Asymptomatic Carotid Disease: a Meta-Analysis

Introduction: The role of positron emission tomography (PET)/computed tomography (CT) in the determination of inflammation in arterial disease is not well defined. This can provide information about arterial wall inflammation in atherosclerotic disease, and may give insight into plaque stability. The aim of this review was to perform a meta-analysis of PET/CT with F-18-FDG (fluorodeoxyglucose) uptake in symptomatic and asymptomatic carotid artery disease. Methods: This was a systematic review, following PRISMA guidelines, which interrogated the MEDLINE database from January 2001 to May 2017. The search combined the terms, "inflammation", "FDG", and "stroke". The search criteria included all types of studies, with a primary outcome of the degree of arterial vascular inflammation determined by F-18-FDG uptake. Analysis involved an inverse weighted variance estimate of pooled data, using a random effects model. Results: A total of 14 articles (539 patients) were included in the meta-analysis. Comparing carotid artery F-18-FDG uptake in symptomatic versus asymptomatic disease yielded a standard mean difference of 0.94 (95% CI 0.58-1.130; p < .0001; I-2 = 65%). Conclusions: PET/CT using F-18-FDG can demonstrate carotid plaque inflammation, and is a marker of symptomatic disease. Further studies are required to understand the clinical implication of PET/CT as a risk prediction tool. (C) 2018 The Authors. Published by Elsevier B.V. on behalf of European Society for Vascular Surgery.