Objective:18F-FDG PET/CT can acquire both anatomical and functional images in a single session. We investigated which factors of 18F-FDG PET/CT imaging have potential as biomarkers for an increased risk of ischemic stroke in cancer patients.
Methods: One hundred and thirty-four cancer patients were enrolled. A new infarct lesion in brain MRI within 1 year after FDG PET/CT defined future ischemic stroke. A target-to-background ratio (TBR) for each arterial segment defined arterial inflammation on PET imaging. Abdominal obesity was defined as area and proportion of visceral adipose tissue (VAT), subcutaneous adipose tissue and total adipose tissue (TAT), on a single CT slice at the umbilical level.
Results: Thirty patients experienced the occurrence of future ischemic stroke confirmed by MRI. Patients who suffered a stroke had TBRs in carotid arteries and the abdominal aorta (P<0.001) that were higher than those in patients without stroke. Patients with stroke had higher VAT (P=0.021) and TAT (P=0.041) proportions than patients without stroke. Multiple logistic regression analysis showed that TBRs of the carotid arteries and abdominal aorta, VAT and TAT proportions, and metabolically active tumors were significantly associated with future ischemic stroke. The combination of PET and CT variables improved predictive power for future ischemic stroke.
Conclusion: Our findings suggest that arterial FDG uptake and hypermetabolic malignancy on PET, and VAT proportion on CT, could be independent predictors of future ischemic stroke in patients with cancer and identify those patients who would benefit from medical treatment.