Figure 4.

Coronary PET Inflammation Imaging: High-Risk CT Features

(A) X-ray and (D) CT coronary angiograms of a 67-year-old man with stable angina, showing minor LCx atheroma (hatched oval) with spotty calcification ([inset] *calcium scan) and calcified plaque in the LAD artery. Although ⁶⁸Ga-DOTATATE PET (B, E) allows unimpeded interpretation of inflammation in the LCx lesion (B, arrow), and lack of signal in the LAD, coronary [¹⁸F]FDG imaging is obscured by patchy myocardial tracer uptake (C). Graphs compare ⁶⁸Ga-DOTATATE (F) with [¹⁸F]FDG (G) coronary TBR_max values by CT plaque morphology in coronary segments (⁶⁸Ga-DOTATATE: NCP or MP, n = 86; normal, n = 45; spotty calcium, n = 30; large calcium, n = 72; LA or PR, n = 11; no high-risk CT, n = 186; [¹⁸F]FDG: NCP or MP, n = 43; normal, n = 13; spotty calcium, n = 15; large calcium n = 14; LA or PR, n = 4; no high-risk CT, n = 66), and ROC analysis demonstrating good diagnostic accuracy for high-risk coronary lesions. LA = low attenuation; LAD = left anterior descending; LCx = left circumflex; NCP = noncalcified plaque; MP = mixed plaque; PR = positive remodeling; other abbreviations in Figures 1, 2, and 3.