期刊
CIRCULATION-CARDIOVASCULAR IMAGING
卷 9, 期 11, 页码 -出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCIMAGING.116.004656
关键词
abdominal aortic aneurysm; fluorodeoxyglucose F18; inflammation; mechanical stress; positron-emission tomography; thrombosis
资金
- British Heart Foundation Cambridge Centre of Excellence [RE/13/6/30180]
- Heart Research UK [RG2638/14/16]
- EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging [EP/N014588/1]
- National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre
- Wellcome Trust [104492/Z/14/Z, WT103782AIA]
- NIHR Cambridge Biomedical Research Centre
- British Heart Foundation
- Higher Education Funding Council for England (HEFCE)
- British Heart Foundation [CH/09/002]
- Wellcome Trust [104492/Z/14/Z] Funding Source: Wellcome Trust
- EPSRC [EP/N014588/1] Funding Source: UKRI
- MRC [G0701127, MC_PC_12040] Funding Source: UKRI
Background-Abdominal aortic aneurysm (AAA) wall inflammation and mechanical structural stress may influence AAA expansion and lead to rupture. We hypothesized a positive correlation between structural stress and fluorine-18-labeled 2-deoxy-2-fluoro-D-glucose (F-18-FDG) positron emission tomography-defined inflammation. We also explored the influence of computed tomography-derived aneurysm morphology and composition, including intraluminal thrombus, on both variables. Methods and Results-Twenty-one patients (19 males) with AAAs below surgical threshold (AAA size was 4.10 +/- 0.54 cm) underwent F-18-FDG positron emission tomography and contrast-enhanced computed tomography imaging. Structural stresses were calculated using finite element analysis. The relationship between maximum aneurysm F-18-FDG standardized uptake value within aortic wall and wall structural stress, patient clinical characteristics, aneurysm morphology, and compositions was explored using a hierarchical linear mixed-effects model. On univariate analysis, local aneurysm diameter, thrombus burden, extent of calcification, and structural stress were all associated with F-18-FDG uptake (P<0.05). AAA structural stress correlated with F-18-FDG maximum standardized uptake value (slope estimate, 0.552; P<0.0001). Multivariate linear mixed-effects analysis revealed an important interaction between structural stress and intraluminal thrombus in relation to maximum standardized uptake value (fixed effect coefficient, 1.68 [SE, 0.10]; P<0.0001). Compared with other factors, structural stress was the best predictor of inflammation (receiver-operating characteristic curve area under the curve =0.59), with higher accuracy seen in regions with high thrombus burden (area under the curve =0.80). Regions with both high thrombus burden and high structural stress had higher F-18-FDG maximum standardized uptake value compared with regions with high thrombus burdens but low stress (median [interquartile range], 1.93 [1.60-2.14] versus 1.14 [0.90-1.53]; P<0.0001). Conclusions-Increased aortic wall inflammation, demonstrated by F-18-FDG positron emission tomography, was observed in AAA regions with thick intraluminal thrombus subjected to high mechanical stress, suggesting a potential mechanistic link underlying aneurysm inflammation.
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