Positron emission tomography (PET) has become widely established in oncology. Subsequently, a whole new “toolbox” of
tracers have become available to look at different aspects of cancer cell function and dysfunction, including cell protein
production, DNA synthesis, hypoxia and angiogenesis. In the past 5 years, these tools have been used increasingly to look
at the other great killer of the developed world: cardiovascular disease. For example, inflammation of the unstable plaque
can be imaged with 18-fludeoxyglucose (18F-FDG), and this uptake can be quantified to show the effect that statins have
in reducing inflammation and explains how these drugs can reduce the risk of stroke. 18F-FDG has also become
established in diagnosing and monitoring large-vessel vasculitis and has now entered routine practice. Other agents such
as gallium-68 (68Ga) octreotide have been shown to identify vascular inflammation possibly more specifically than 18FFDG.
Hypoxia within the plaque can be imaged with 18F-fluoromisonidazole and resulting angiogenesis with 18F-RGD
peptides. Active calcification such as that found in unstable atheromatous plaques can be imaged with 18F-NaF. PET
imaging enables us to understand the mechanisms by which cardiovascular disease, including atheroma, leads to
morbidity and death and thus increases the chance of finding new and effective treatments.