AccScience Publishing / EJMO / Online First / DOI: 10.36922/ejmo.7727
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ORIGINAL RESEARCH ARTICLE

Arterial tissue-to-psoas muscle ratio: A novel metric for quantifying fluorodeoxyglucose uptake in predicting the association between atherosclerotic inflammation and arterial calcification

Mamdouh S. Al-enezi1*
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1 Department of Diagnostic Radiology, College of Applied Medical Science, University of Hail, Hail, Saudi Arabia
EJMO, 7727 https://doi.org/10.36922/ejmo.7727
Submitted: 16 December 2024 | Revised: 10 January 2025 | Accepted: 22 January 2025 | Published: 12 February 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Atherosclerosis is one of the leading causes of death worldwide. Computed tomography (CT) and positron emission tomography (PET) are valuable tools for assessing atherosclerotic plaque burden and associated physiological processes. The objective of this study is to evaluate the arterial tissue-to-psoas muscle uptake ratio (TMR) as a metric for assessing the relationship between inflammation and arterial calcification. Thirteen atherosclerotic patients were scanned using fluorodeoxyglucose (FDG)-PET/CT. The descending aorta, femoral, and iliac arteries were delineated on PET images and co-registered with corresponding CT slices. Arterial calcium was determined in arterial regions of interest with CT numbers above 130, and calcium level, area, and score were measured and classified into four clusters. FDG aggregation in PET images was assessed using mean TMR, with two cut-off points (1.8 and 2.3). Normality of the FDG signal in the psoas muscle was observed for all participants (p = 0.23). No significant differences in TMR values were observed (TMR, TMR >1.8, and TMR >2.3) across calcium density clusters (p > 0.05). However, a higher calcium area was positively associated with TMR values (p < 0.05) compared to a lower calcium area. The same pattern was observed for calcium score clusters, where higher calcium scores were associated with higher TMR values compared to lower calcium scores (p < 0.05). Using the psoas muscle as a background correction strategy for quantifying FDG uptake is feasible and may help reduce variation seen with a blood-based normalization approach, thus improving the reproducibility of measurements. TMR is a sensitive metric for assessing the relationship between arterial calcification and inflammation. Calcium area is a comparable method to calcium score for quantifying arterial calcium burden.

Keywords
Atherosclerosis
Plaque
Psoas muscle
Calcium
Inflammation
Computed tomography
Fluorodeoxyglucose
Positron emission tomography
Funding
None.
Conflict of interest
The author has no conflicts of interest to disclose.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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