CVD Risk Factors and Their Neurosurgical Significance: Evaluating Cerebral Metabolism with FDG-PET

Introduction: Emerging evidence suggests a robust association between cardiovascular disease (CVD) and cognitive decline. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) has proven efficacious in identifying metabolic neurological changes at a molecular level. This study analyzed regional glucose metabolism in individuals with known CVD risk factors. The detection of such metabolic changes could assist in determining the necessity and timing of vascular interventions, contributing to improved patient outcomes and reduced postoperative complications.

Methods: We compared 79 healthy controls (mean age 44.5 ± 13.8 years, 53.2% males) and 40 individuals (mean age 55.9 ± 11.9 years, 50% males) at increased risk for cardiovascular disease (CVD) as assessed by the systematic coronary risk evaluation tool. All subjects were grouped into two age-matched cohorts. All subjects underwent whole-body FDG-PET/CT imaging. Quantitative regional analysis was performed using MIMneuro. 70 neurological structures were analyzed in each subject. An independent samples t-test was used to assess the differences in z-scores between controls and at-risk subjects.

Results: Within the younger cohort, the cingulate gyrus (p=0.0206) and the anterior cingulate gyrus (p=0.0348) demonstrated significant hypometabolism in patients with known cardiac risk factors when compared to healthy controls. Within the older cohort, the supplementary motor area demonstrated significant hypometabolism (p=0.0145), while both the pons (p=0.0169) and pontine tegmentum (p=0.0063) had significant hypermetabolism in patients with known cardiac risk factors when compared to healthy controls.

Conclusion : The findings substantiate the vulnerability of the cingulate gyrus to the impacts of small vessel disease. The cingulate gyrus, vascularized by the pericallosal arteries, and the pontine tegmentum, supplied by branches of the basilar artery, are pivotal in this context. Calcification within these arteries could potentially instigate decreased perfusion, thereby contributing to the observed hypometabolism. Examining microstructural and functional changes in the neurovascular system provides key insights. These findings could inform targeted interventions, streamline perioperative strategies, and aid in decision-making regarding the timing of vascular interventions.