Novel Targets for Molecular Imaging of Inflammatory Processes of Carotid Atherosclerosis: A Systematic Review

IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Seminars in nuclear medicine Pub Date : 2023-11-23 DOI:10.1053/j.semnuclmed.2023.10.004
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Abstract

Computed tomography angiography (CTA), magnetic resonance angiography (MRA) and 18F-FDG-PET have proven clinical value when evaluating patients with carotid atherosclerosis. In this systematic review, we will focus on the role of novel molecular imaging tracers in that assessment and their potential strengths to stratify stroke risk. We systematically searched PubMed, Embase, the Web of Science Core Collection, and Cochrane Library for articles reporting on molecular imaging to noninvasively detect or characterize inflammation in carotid atherosclerosis. As our focus was on nonclassical novel targets, we omitted reports solely on 18F-FDG and 18F-NaF. We summarized and mapped the selected studies to provide an overview of the current clinical development in molecular imaging in relation to risk factors, imaging and histological findings, diagnostic and prognostic performance. We identified 20 articles in which the utilized tracers to visualize carotid wall inflammation were somatostatin subtype-2- (SST2-) (n = 5), CXC-motif chemokine receptor 4- (CXCR4-) (n = 3), translocator protein- (TSPO-) (n = 2) and aVβ3 integrin-ligands (n = 2) and choline-tracers (n = 2). Tracer uptake correlated with traditional cardiovascular risk factors, that is, age, gender, diabetes, hypercholesterolemia, and hypertension as well as prior cardiovascular disease. We identified discrepancies between tracer uptake and grade of stenosis, plaque calcification, and 18F-FDG uptake, suggesting the importance of alternative characterization of atherosclerosis beyond classical neuroimaging features. Immunohistochemical analysis linked tracer uptake to markers of macrophage infiltration and neovascularization. Symptomatic carotid arteries showed higher uptake compared to asymptomatic (including contralateral, nonculprit) arteries. Some studies demonstrated a potential role of these novel molecular imaging as a specific intermediary (bio)marker for outcome. Several novel tracers show promise for identification of high-risk plaque inflammation. Based on the current evidence we cautiously propose the SST2-ligands and the choline radiotracers as viable candidates for larger prospective longitudinal outcome studies to evaluate their predictive use in clinical practice.

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颈动脉粥样硬化炎症过程分子成像的新靶点:系统综述。
计算机断层血管造影(CTA)、磁共振血管造影(MRA)和18F-FDG-PET在评估颈动脉粥样硬化患者时已被证明具有临床价值。在这篇系统综述中,我们将重点关注新型分子成像示踪剂在评估中的作用及其在卒中风险分层中的潜在优势。我们系统地检索了PubMed、Embase、Web of Science Core Collection和Cochrane Library中关于分子成像无创检测或表征颈动脉粥样硬化炎症的文章。由于我们的重点是非经典的新目标,我们省略了仅关于18F-FDG和18F-NaF的报告。我们总结并绘制了所选研究,概述了分子影像学在危险因素、影像学和组织学发现、诊断和预后表现方面的临床发展。我们确定了20篇文章利用示踪剂的可视化颈动脉壁炎症是生长激素抑制素亚型2 - (SST2) (n = 5),CXC-motif趋化因子受体4 - (CXCR4) (n = 3)转运蛋白蛋白质——(TSPO) (n = 2)和aVβ3 integrin-ligands (n = 2)和choline-tracers (n = 2)。示踪剂摄取与传统的心血管危险因素相关,即年龄、性别、糖尿病、高胆固醇血症、高血压以及既往心血管疾病。我们发现了示踪剂摄取与狭窄等级、斑块钙化和18F-FDG摄取之间的差异,这表明除了经典的神经影像学特征外,动脉粥样硬化的其他特征也很重要。免疫组织化学分析将示踪剂摄取与巨噬细胞浸润和新生血管的标志物联系起来。有症状的颈动脉比无症状的(包括对侧、非罪魁祸首)动脉摄取更高。一些研究表明,这些新的分子成像作为结果的特定中介(生物)标记物的潜在作用。几种新型示踪剂有望用于识别高风险斑块炎症。基于目前的证据,我们谨慎地提出sst2配体和胆碱放射性示踪剂作为更大规模的前瞻性纵向结果研究的可行候选者,以评估它们在临床实践中的预测用途。
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来源期刊
Seminars in nuclear medicine
Seminars in nuclear medicine 医学-核医学
CiteScore
9.80
自引率
6.10%
发文量
86
审稿时长
14 days
期刊介绍: Seminars in Nuclear Medicine is the leading review journal in nuclear medicine. Each issue brings you expert reviews and commentary on a single topic as selected by the Editors. The journal contains extensive coverage of the field of nuclear medicine, including PET, SPECT, and other molecular imaging studies, and related imaging studies. Full-color illustrations are used throughout to highlight important findings. Seminars is included in PubMed/Medline, Thomson/ISI, and other major scientific indexes.
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