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High tissue matrix metalloproteinase (MMP) activity has been associated with advanced atherosclerosis and plaque rupture. ¹⁸F-FDG uptake has been reported to detect inflammation. This investigation examined the vascular ¹⁸F-FDG uptake by PET/CT and its correlation with circulating MMP-1 levels. We examined 25 consecutive patients with significant carotid stenosis and 22 healthy control subjects using ¹⁸F-FDG PET/CT. The leukocyte counts, C-reactive protein (CRP), and MMP-1 were measured. ¹⁸F-FDG arterial uptake, as well as calcifications, was significantly higher in extensive distributions in patients with established carotid stenosis. However, their distribution was not consistently overlapping. The values of circulating MMP-1 and leukocyte counts were significantly higher in patients with carotid stenosis (all P < 0.05). In addition, subjects with higher ¹⁸F-FDG uptake (maximum SUV > …