Determinants of 18F-NaF uptake in femoral arteries in patients with type 2 diabetes mellitus

Abstract

Background The goal of this study was to investigate the potential determinants of 18F-NaF uptake in femoral arteries as a marker of arterial calcification in patients with type 2 diabetes and a history of arterial disease. Methods and Results The study consisted of participants of a randomized controlled trial to investigate the effect of vitamin K2 (NCT02839044). In this prespecified analysis, subjects with type 2 diabetes and known arterial disease underwent full body 18F-NaF PET/CT. Target-to-background ratio (TBR) was calculated by dividing the mean SUVmax from both superficial femoral arteries by the SUVmean in the superior vena cava (SVC) and calcium mass was measured on CT. The association between 18F-NaF TBR and cardiovascular risk factors was investigated using uni- and multivariate linear regression corrected for age and sex. In total, 68 patients (mean age: 69 ± 8 years; male: 52) underwent 18F-NaF PET/CT. Higher CT calcium mass, total cholesterol, and HbA1c were associated with higher 18F-NaF TBR after adjusting. Conclusion This study shows that several modifiable cardiovascular risk factors (total cholesterol, triglycerides, HbA1c) are associated with femoral 18F-NaF tracer uptake in patients with type 2 diabetes.

Atherosclerosis Imaging with 18F-Sodium Fluoride PET

“…We found 35 eligible articles. Three on the aortic valve ( n = 3) and seven on methodology ( n = 7) were excluded based on the abovementioned criteria, leaving 25 dealing with the coronary arteries [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ], femoral artery [ 12 , 13 , 14 , 15 ], abdominal aorta [ 16 , 17 , 18 ], carotid arteries [ 19 , 20 ], thoracic aorta [ 21 ], and intracranial [ 22 ], renal [ 23 ], and penile arteries [ 24 ]. One study focused on the carotid and cerebral arteries [ 25 ], another on the carotids, the aortic arch, and coronary arteries [ 26 ], and a third on several major arteries [ 27 ].…”

“…One study focused on the carotid and cerebral arteries [ 25 ], another on the carotids, the aortic arch, and coronary arteries [ 26 ], and a third on several major arteries [ 27 ]. Below (and in Supplementary Materials Tables S1–S5 ), the literature is summarized in six sections before being debated in the discussion: Disease mechanisms and targeting [ 10 ], Early detection and prevalence of NaF uptake in the heart and major arteries [ 5 , 23 , 24 , 25 , 27 ], NaF uptake in vulnerable, high risk, and ruptured plaque [ 6 , 7 , 8 , 9 , 19 , 20 ], Influence of age, sex, and other factors on NaF uptake [ 3 , 16 , 22 ], Association between NaF uptake and cardiovascular risk factors [ 4 , 15 , 21 ], NaF uptake and disease progression [ 11 , 12 , 13 , 14 , 17 , 18 , 26 ]. …”

“…In 40 patients with suspected coronary artery disease, including 17 (43%) with DM, Ryoo et al demonstrated that the burden of NaF in the descending thoracic aorta correlated significantly with DM and serum HbA1c level, whereas overall burden of CT-calcium deposition correlated with hypertension, metabolic syndrome, and 10-year CVD risk score [ 21 ]. Lastly, Takx et al demonstrated that total cholesterol, triglycerides, and HbA1c are associated with NaF uptake in the femoral arteries of DM2 patients [ 15 ].…”

“…Ryoo reported that in patients with suspected CAD, the burden of NaF uptake in the descending thoracic aorta was significantly associated with diabetes mellitus and serum HbA1c level, while the overall burden of CT calcium deposition correlated significantly with hypertension, metabolic syndrome, and 10-year CVD risk score [ 21 ]. Takx et al demonstrated that higher CT calcium, total cholesterol, and HbA1c were associated with higher NaF TBR in the femoral arteries of DM2 patients [ 15 ].…”

Noninvasive Detection of Active Microcalcification in an Occlusive Peripheral Vascular Aneurysm Using 18F-NaF PET/CT Imaging

“… 2 , 3 Although 18 F-NaF PET/CT imaging investigations have traditionally evaluated coronary artery plaque remodeling, 1 recent work has also begun to assess the utility of PET/CT for evaluating abdominal aortic aneurysms, 4 – 7 carotid arteries, 8 , 9 and femoral arteries. 10 , 11 This report documents a case of active microcalcification in a lower extremity aneurysm and in below-the-knee arteries using 18 F-NaF PET/CT. Further application of PET/CT imaging in PAD patients could provide novel insight into the calcification of peripheral arteries and aneurysms, thereby potentially providing guidance for therapeutic strategies and lifestyle modifying behaviors focused on preventing and/or inhibiting the development of life-limiting and limb-threatening peripheral atherosclerosis.…”