Page 222 - EJMO-9-1

Eurasian Journal of Medicine
and Oncology

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-enezi*
Department of Diagnostic Radiology, College of Applied Medical Science, University of Hail, Hail,
Saudi Arabia

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
*Corresponding author: were delineated on PET images and co-registered with corresponding CT slices.
Mamdouh S. Al-enezi Arterial calcium was determined in arterial regions of interest with CT numbers
(ms.alenezi@uoh.edu.sa) above 130, and calcium level, area, and score were measured and classified into four
Citation: Al-enezi MS. Arterial clusters. FDG aggregation in PET images was assessed using mean TMR, with two cut-
tissue-to-psoas muscle ratio: off points (1.8 and 2.3). Normality of the FDG signal in the psoas muscle was observed
A novel metric for quantifying
fluorodeoxyglucose uptake in for all participants (p = 0.23). No significant differences in TMR values were observed
predicting the association between (TMR, TMR >1.8, and TMR >2.3) across calcium density clusters (p > 0.05). However, a
atherosclerotic inflammation and higher calcium area was positively associated with TMR values (p < 0.05) compared
arterial calcification. Eurasian J Med to a lower calcium area. The same pattern was observed for calcium score clusters,
Oncol. 2025;9(1):214-222.
doi: 10.36922/ejmo.7727 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
Received: December 16, 2024
strategy for quantifying FDG uptake is feasible and may help reduce variation seen
Revised: January 10, 2025 with a blood-based normalization approach, thus improving the reproducibility
Accepted: January 22, 2025 of measurements. TMR is a sensitive metric for assessing the relationship between
arterial calcification and inflammation. Calcium area is a comparable method to
Published online: February 12,
2025 calcium score for quantifying arterial calcium burden.
Copyright: © 2025 Author(s).
This is an Open-Access article Keywords: Atherosclerosis; Plaque; Psoas muscle; Calcium; Inflammation; Computed
distributed under the terms of the
Creative Commons Attribution tomography; Fluorodeoxyglucose; Positron emission tomography
License, permitting distribution,
and reproduction in any medium,
provided the original work is
properly cited. 1. Introduction
Publisher’s Note: AccScience
Publishing remains neutral with Atherosclerosis is a chronic inflammatory disease with multifactorial causes and is
regard to jurisdictional claims in
published maps and institutional considered a leading cause of cardiovascular diseases (CVD), as well as cardiovascular
2
1
affiliations morbidity and mortality worldwide, including sudden death. It is characterized by
Volume 9 Issue 1 (2025) 214 doi: 10.36922/ejmo.7727