Nuclear imaging offers possibility for early detection of patients with coronary heart disease

Nuclear imaging will play an increasing role in both the detection of atherosclerosis (coronary heart disease) and, more specifically, the composition of plaque build up that can block the flow of blood through an artery, according to journal reports published by the Society of Nuclear Medicine.

A trio of articles, “Evaluation of 18F-FDG Uptake and Arterial Wall Calcifications Using 18F-FDG PET/CT,” “Molecular and Metabolic Imaging of Atherosclerosis” and “Noninvasive Imaging of Atherosclerosis: The Biology Behind the Pictures,” appears in the November 2004 issue of “The Journal of Nuclear Medicine.”

Heart disease, in the news recently because of former President Bill Clinton’s quadruple coronary artery bypass surgery, is one of the leading causes of death worldwide. According to SNM members Simona Ben-Haim, M.D., and Ora Israel, M.D., “combined positron emission tomography and computed tomography may be helpful in the detection of early abnormalities in the arterial wall.” They said, “These abnormalities may be the cause of future severe cardiovascular events … the PET/CT scan may be potentially useful in early detection of disease, prevention, monitoring response to therapy and prognosis.” This preliminary study, which took more than three years, could establish a role for nuclear medicine as a noninvasive imaging tool for atherosclerosis, providing both functional and anatomical information. The results of the study, one of the first of its kind, are detailed in “Evaluation of 18F-FDG Uptake and Arterial Wall Calcifications Using 18F-FDG PET/CT.” While the results are exciting, the two authors said that more research is needed “to confirm our results and lead to the understanding of their clinical significance.”

While Clinton’s angiogram showed he had blockage in some coronary arteries caused by fatty plaque accumulated over the years, the authors of “Molecular and Metabolic Imaging of Atherosclerosis” pointed out that, “recent advances in understanding of the pathobiology of atherosclerosis have highlighted the inadequacies” of imaging the disease with X-ray angiography. John R. Davies, B.Sc.; James H. Rudd, Ph.D.; and Peter L. Weissberg, M.D., stated the need for better imaging approaches and outlined the biology of atherosclerosis, reviewing both invasive and noninvasive (such as 18F-FDG PET) imaging techniques available, especially those that detect metabolic or inflammatory changes within detected plaque. Advances in understanding cell biology show a need for imaging techniques that can provide information about plaque composition and drive the development of more informative imaging techniques, they say. “Nuclear imaging has the potential to provide invaluable information on the cellular, metabolic and molecular composition of the plaque,” note the authors.

In the journal’s invited perspective, “Noninvasive Imaging of Atherosclerosis: The Biology Behind the Pictures,” Weissberg writes, “It has taken the best part of 50 years for us to learn that angiography tells us very little about atherosclerotic plaques.” He added, “It is crucial that we learn more quickly what newer imaging techniques are telling us.”