64Cu-DOTATATE PET/MRI for Detection of Activated Macrophages in Carotid Atherosclerotic Plaques: Studies in Patients Undergoing Endarterectomy

OBJECTIVE—A feature of vulnerable atherosclerotic plaques of the carotid artery is high activity and abundance of lesion macrophages. There is consensus that this is of importance for plaque vulnerability, which may lead to clinical events, such as stroke and transient ischemic attack. We used positron emission tomography (PET) and the novel PET ligand [Cu] [1,4,7,10-tetraazacyclododecane-N,N′,N″,N‴-tetraacetic acid]-d-Phe1,Tyr3-octreotate (Cu-DOTATATE) to specifically target macrophages via the somatostatin receptor subtype-2 in vivo. APPROACH AND RESULTS—Ten patients underwent simultaneous PET/MRI to measure Cu-DOTATATE uptake in carotid artery plaques before carotid endarterectomy. Cu-DOTATATE uptake was significantly higher in symptomatic plaque versus the contralateral carotid artery (P