Psoriasis is a common, chronic inflammatory skin disease driven by immune dysregulation involving helper T cell 17 pathways. Psoriasis is associated with systemic inflammation, which increases the risk of joint disease (psoriatic arthritis), subclinical cardiovascular disease, and major adverse cardiovascular events, especially in young patients with severe skin disease. Furthermore, vascular inflammation by 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) provides a valuable tool with utility in predicting future cardiovascular events. As such, psoriasis provides a clinical human model to characterize the vascular disease by non-invasive imaging techniques such as vascular inflammation by FDG PET/CT.

FDG PET/CT has garnered considerable interest in multiple completed and ongoing cardiovascular and psoriasis trials. Indeed, recent studies have shown that psoriasis is associated with increased vascular inflammation. Furthermore, a dose-response was demonstrated between severity of skin disease and severity of vascular inflammation in psoriasis. Additionally, observational studies have reported that treatment of psoriasis decreases vascular inflammation with several randomized trials still ongoing. Emerging data from a single report demonstrated that use of FDG PET/MRI may provide soft tissue localization of the FDG tracer in the aorta and the carotids but larger studies are underway.

This review outlines the initial use, development, and current utility of FDG PET/CT in psoriasis covering cross-sectional and longitudinal studies that examined the relationship between psoriasis, severity of skin disease, presence of joint disease, treatment of skin disease, and emerging techniques to identify vascular inflammation as a marker of cardiovascular risk in psoriasis.