Coronary Arterial 18F-Sodium Fluoride Uptake

Dweck, Marc R; Chow, Marcus W. L.; Joshi, N. V.; Williams, Michelle; Jones, Charlotte; Fletcher, Alison; Richardson, Henry S.; White, Audrey; McKillop, Graham; Beek, Edwin Jacques Rudolph van; Boon, Nicholas A.; Rudd, James H.F.; Newby, David E.

doi:10.1016/j.jacc.2011.12.037

Cited by 442 publications

(202 citation statements)

References 41 publications

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“…Several other studies have reported similar findings and have led to growing support for the use of 18 F‐NaF for imaging the process of microcalcification and visualizing ongoing mineral deposition within the atherosclerotic plaque 64, 99, 100, 101, 102, 103…”

Section: Positron Emission Tomographymentioning

confidence: 64%

“…Dweck et al64 observed that in spite of a strong correlation between 18 F‐NaF uptake and CACS ( r =0.652, P <0.001), there was no corresponding 18 F‐NaF uptake in many of the densely calcified regions on CT. In fact, 41% of patients with CACS >1000 had no significant 18 F‐NaF uptake, and often 18 F‐NaF uptake was found in areas adjacent to and remote from existing coronary calcification.…”

Section: Positron Emission Tomographymentioning

confidence: 98%

“…However, there are important limitations of CACS including that it generally only represents ≈20% of total plaque volume, it cannot be used to determine if there is flow‐limiting stenosis, and it does not provide information on plaque morphology or subtype because of its lower resolution and poor tissue contrast 62. CACS CT imaging is also unable to detect calcification accurately at a molecular level33 and does not discriminate between microcalcification and macrocalcification, potential markers of vulnerable and stable atherosclerotic plaques, respectively 63, 64…”

Section: Multimodality Imaging Techniquesmentioning

confidence: 99%

“…The radiotracer binds and incorporates onto the surface of hydroxyapatite crystals by exchanging with hydroxyl ions to form the fluoroapatite 64, 93. Although the most commonly implemented clinical nuclear bone tracer is a technetium‐based radiotracer compound that is imaged with single photon emission computed tomography, 18 F‐NaF has superior characteristics for bone imaging because of the improved resolution of positron emission tomography (PET) in comparison to single photon emission computed tomography.…”

Section: Positron Emission Tomographymentioning

confidence: 99%

“…Recently, substantial attention has been given to using 18 F‐NaF to investigate vascular calcification in the coronary arteries,22, 64 the aorta,99 and the carotid arteries,100 and it has rapidly gained acceptance as a useful tool for the investigation of plaque pathobiology.…”

Section: Positron Emission Tomographymentioning

confidence: 99%

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Imaging Cardiovascular Calcification

Wang

Osborne

Tung

et al. 2018

JAHA

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Section: Positron Emission Tomographymentioning

confidence: 64%

Section: Positron Emission Tomographymentioning

confidence: 98%

Section: Multimodality Imaging Techniquesmentioning

confidence: 99%

Section: Positron Emission Tomographymentioning

confidence: 99%

Section: Positron Emission Tomographymentioning

confidence: 99%

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Imaging Cardiovascular Calcification

Wang

Osborne

Tung

et al. 2018

JAHA

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Coronary Atherosclerotic Plaque Activity and Future Coronary Events

et al. 2023

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ImportanceRecurrent coronary events in patients with recent myocardial infarction remain a major clinical problem. Noninvasive measures of coronary atherosclerotic disease activity have the potential to identify individuals at greatest risk.ObjectiveTo assess whether coronary atherosclerotic plaque activity as assessed by noninvasive imaging is associated with recurrent coronary events in patients with myocardial infarction.Design, Setting, and ParticipantsThis prospective, longitudinal, international multicenter cohort study recruited participants aged 50 years or older with multivessel coronary artery disease and recent (within 21 days) myocardial infarction between September 2015 and February 2020, with a minimum 2 years’ follow-up.InterventionCoronary 18F-sodium fluoride positron emission tomography and coronary computed tomography angiography.Main Outcomes and MeasuresTotal coronary atherosclerotic plaque activity was assessed by 18F-sodium fluoride uptake. The primary end point was cardiac death or nonfatal myocardial infarction but was expanded during study conduct to include unscheduled coronary revascularization due to lower than anticipated primary event rates.ResultsAmong 2684 patients screened, 995 were eligible, 712 attended for imaging, and 704 completed an interpretable scan and comprised the study population. The mean (SD) age of participants was 63.8 (8.2) years, and most were male (601 [85%]). Total coronary atherosclerotic plaque activity was identified in 421 participants (60%). After a median follow-up of 4 years (IQR, 3-5 years), 141 participants (20%) experienced the primary end point: 9 had cardiac death, 49 had nonfatal myocardial infarction, and 83 had unscheduled coronary revascularizations. Increased coronary plaque activity was not associated with the primary end point (hazard ratio [HR], 1.25; 95% CI, 0.89-1.76; P = .20) or unscheduled revascularization (HR, 0.98; 95% CI, 0.64-1.49; P = .91) but was associated with the secondary end point of cardiac death or nonfatal myocardial infarction (47 of 421 patients with high plaque activity [11.2%] vs 19 of 283 with low plaque activity [6.7%]; HR, 1.82; 95% CI, 1.07-3.10; P = .03) and all-cause mortality (30 of 421 patients with high plaque activity [7.1%] vs 9 of 283 with low plaque activity [3.2%]; HR, 2.43; 95% CI, 1.15-5.12; P = .02). After adjustment for differences in baseline clinical characteristics, coronary angiography findings, and Global Registry of Acute Coronary Events score, high coronary plaque activity was associated with cardiac death or nonfatal myocardial infarction (HR, 1.76; 95% CI, 1.00-3.10; P = .05) but not with all-cause mortality (HR, 2.01; 95% CI, 0.90-4.49; P = .09).Conclusions and RelevanceIn this cohort study of patients with recent myocardial infarction, coronary atherosclerotic plaque activity was not associated with the primary composite end point. The findings suggest that risk of cardiovascular death or myocardial infarction in patients with elevated plaque activity warrants further research to explore its incremental prognostic implications.

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Can Noncalcified Plaques Contribute to Future Coronary Events?

Erbay,

Susarla,

Budoff

2024

JAMA Cardiol

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To the Editor Moss et al 1 recently published a prospective, international, multicenter longitudinal cohort study of 704 patients with recent myocardial infarction (MI) that investigated whether coronary atherosclerotic plaque activity as assessed by 18 F-sodium fluoride positron emission tomography (PET) and coronary computed tomography (CT) angiography is associated with recurrent coronary events. Their findings suggest that coronary atherosclerotic plaque activity is not associated with cardiac death, nonfatal MI, or revascularization after a minimum 2-year follow-up period. This is a significant study with a large sample size that used a novel and promising marker to assess plaque activity.While this study demonstrates no effect of coronary atherosclerotic plaque activity on future coronary events, it is important to recognize the limitations of PET-CT in evaluating all aspects of plaque characteristics. 18 F-sodium fluoride PET-CT allows quantification of coronary microcalcifications to evaluate plaque activity; soft plaques lack visible calcification, which limits their detection by PET-CT, as they do not uptake radiotracers typically used in PET imaging. Soft plaque burden can be quantified via other measurement tools in different imaging modalities; for example, the SCOT-HEART study used low-attenuation plaque (LAP) as a measurement tool acquired by coronary CT angiography and found LAP plaque burden to be the strongest predictor of fatal or nonfatal MI. 2 LAP, characterized by its low density on coronary CT angiography, represents soft, lipid-rich plaques prone to rupture. Thus, not considering the additional effects of soft plaques should be stated as a limitation of PET-CT studies investigating coronary plaque progression.In addition to the evaluation of soft plaques with coronary CT angiography, the use of other PET-CT markers, eg, 18 Ffluorodeoxyglucose 68 Ga-DOTATATE, to visualize earlier stages of atherosclerosis, such as inflammation and macrophage activity, could provide additional resolution. 3,4 To fully gauge the primary end points of this study, it is important to use a variety of markers. In conclusion, the authors should be recognized for this significant and challenging study. Future research should strive to integrate multiple imaging modalities and comprehensively evaluate various plaque characteristics to improve risk prediction models and enhance patient care.

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Coronary Arterial 18F-Sodium Fluoride Uptake

Cited by 442 publications

References 41 publications

Imaging Cardiovascular Calcification

Imaging Cardiovascular Calcification

Coronary Atherosclerotic Plaque Activity and Future Coronary Events

Can Noncalcified Plaques Contribute to Future Coronary Events?

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