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  • Review Article
  • Published:

PET imaging of the neurovascular interface in cerebrovascular disease

Nature Reviews Neurology volume 13, pages 676–688 (2017)Cite this article

Subjects

A Corrigendum to this article was published on 03 April 2018

This article has been updated

Key Points

  • PET enables noninvasive detection and quantification of inflammation, microcalcification and hypoxia, which are all associated with plaque rupture in carotid atherosclerosis

  • The temporospatial evolution of acute ischaemia and secondary neuroinflammation can be visualized using PET

  • PET studies have elucidated complex interactions between cerebral small vessel disease, neuroinflammation and amyloid deposition, and demonstrated different uptake patterns in vascular cognitive impairment

  • PET-based metabolic imaging not only offers improved understanding of disease mechanisms but also provides sensitive end points for use in clinical trials and has the potential to improve clinical risk-stratification

Abstract

Cerebrovascular disease encompasses a range of pathologies that affect different components of the cerebral vasculature and brain parenchyma. Large artery atherosclerosis, acute cerebral ischaemia, and intracerebral small vessel disease all demonstrate altered metabolic processes that are key to their pathogenesis. Although structural imaging techniques such as MRI are the mainstay of clinical care and research in cerebrovascular disease, they have limited ability to detect these pathophysiological processes in vivo. By contrast, PET can detect and quantify metabolic processes that are relevant to each facet of cerebrovascular disease. Information obtained from PET studies has helped to shape the understanding of key concepts in cerebrovascular medicine, including vulnerable atherosclerotic plaque, salvageable ischaemic penumbra, neuroinflammation and selective neuronal loss after ischaemic insult. PET has also helped to elucidate the relationships between chronic hypoxia, neuroinflammation, and amyloid-β deposition in cerebral small vessel disease. This Review describes how PET-based imaging of metabolic processes at the neurovascular interface has contributed to our understanding of cerebrovascular disease.

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Figure 1: Carotid artery inflammation detected using 18F-FDG-PET.
Figure 2: Carotid artery inflammation detected using 68Ga-DOTATATE-PET.
Figure 3: The three main pathophysiological profiles in patients with acute stroke as shown by 15O-PET.
Figure 4: 11C-PK11195-PET scans showing the evolution of neuroinflammation in a patient after stroke.
Figure 5: Interaction between infarction and amyloid deposition.

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Change history

  • 03 April 2018

    In this article as originally published, Prof. J. C. Baron was credited as the source of Figure 3. However, we omitted to state that permission to reproduce Figure 3 was obtained from Oxford University Press, the publisher of Prof. J. C. Baron’s article. This omission has been corrected online as of 3 April 2018.

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Acknowledgements

N.R.E. is supported by a research training fellowship from The Dunhill Medical Trust (grant number RTF44/0114). J.M.T. is supported by a Wellcome Trust research training fellowship (104492/Z/14/Z). J.H.F.R. is part-supported by the Higher Education Funding Council for England (HEFCE), the British Heart Foundation, and the Wellcome Trust. H.S.M. is supported by the Medical Research Council (MRC) as a National Institute for Health Research (NIHR) Senior Investigator. E.A.W. is supported by the British Heart Foundation. H.S.M., J.H.F.R., and E.A.W. are supported by the NIHR Cambridge Biomedical Research Centre.

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Authors and Affiliations

  1. Department of Clinical Neurosciences, University of Cambridge, Box 83, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK

    Nicholas R. Evans, Hugh S. Markus & Elizabeth A. Warburton

  2. Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK

    Jason M. Tarkin & James H. F. Rudd

  3. Department of Nuclear Medicine, Box 219, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK

    John R. Buscombe

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N.R.E. wrote the manuscript. N.R.E., J.M.T. and J.H.F.R. researched data for the article. All authors (N.R.E., J.M.T., J.R.B., H.S.M., J.H.F.R. & E.A.W.) contributed substantially to discussions of the article content and undertook review and/or editing of the manuscript before submission.

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Evans, N., Tarkin, J., Buscombe, J. et al. PET imaging of the neurovascular interface in cerebrovascular disease. Nat Rev Neurol 13, 676–688 (2017). https://doi.org/10.1038/nrneurol.2017.129

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