NaF-PET Imaging of Atherosclerosis Burden

Høilund‐Carlsen, Poul Flemming; Piri, Reza; Gerke, Oke; Sturek, Michael; Werner, Thomas; Revheim, Mona‐Elisabeth; Alavi, Abass

doi:10.3390/jimaging9020031

Cited by 4 publications

(5 citation statements)

References 69 publications

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“…Another clinical trial by Joshi et al demonstrated that NaF-PET was more sensitive than FDG-PET in detecting calcified plaque in the coronary arteries of patients with stable angina [8]. Other studies have investigated the utility of NaF-PET/CT for atherosclerosis detection, demonstrating its ability to identify microcalcification prior to macrocalcification [9,10]. This case report demonstrates the utility of NaF-PET/CT imaging in assessing active carotid atherogenesis in a patient with minimal FDG uptake.…”

Section: Introductionmentioning

confidence: 75%

The Emerging Role of NaF-PET/CT in Detecting Vascular Microcalcification in the Pathogenesis of Neurological Dysfunction

Teichner,

Subtirelu,

Ashok

et al. 2023

JVD

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Cerebrovascular disease (CVD) is a global health concern, and early detection is crucial for effective intervention. This case report presents a 31-year-old male patient with multiple cardiac risk factors who underwent positron emission tomography/computed tomography (PET/CT) with 18F-sodium fluoride (NaF) and 18F-fluorodeoxyglucose (FDG) to evaluate for the presence and degree of atherosclerosis in the aorta, carotid arteries, coronary arteries, iliac arteries, and the femoral arteries. Elevated NaF uptake within the bilateral carotid arteries signified substantial ongoing vascular microcalcification. Reduced global brain metabolism and region-specific hypometabolism measured with FDG PET indicated potential cerebrovascular mechanisms that may be influencing neurological function. The findings highlight the potential of emerging PET tracers, such as NaF, to improve the diagnostic accuracy and therapeutic management of CVD. This case emphasizes the importance of a comprehensive diagnostic approach as well as continued investigation into CVD pathophysiology using PET-based techniques, which may guide the development of innovative therapeutic strategies.

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Section: Introductionmentioning

confidence: 75%

The Emerging Role of NaF-PET/CT in Detecting Vascular Microcalcification in the Pathogenesis of Neurological Dysfunction

Teichner,

Subtirelu,

Ashok

et al. 2023

JVD

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“…To address these limitations, [ 18 F] NaF PET/CT offers a promising imaging modality for the early detection of atherosclerotic plaque formation by identifying changes at the molecular level. Following chemisorption, the 18 F ion exchanges rapidly for the OHion of hydroxyapatite to form fluorapatite. Since hydroxyapatite in macroscopic deposits is internalized, and [ 18 F] NaF is unable to penetrate the crystalline mass, [ 18 F] NaF binding is able to specifically detect new calcifying activity [41].…”

Section: Discussionmentioning

confidence: 99%

“…The hybrid technology of PET and computed tomography (PET/CT) offers an enhanced spatial resolution, along with the capability to visualize molecular alterations throughout the progression of atherosclerosis [16]. The tracers most frequently utilized for this purpose are [ 18 F] fluorodeoxyglucose (FDG) and [ 18 F] sodium fluoride (NaF), which serve as indicators of inflammation and active microcalcification, respectively [17,18]. FDG-PET/CT has previously been correlated with carotid artery inflammation, which cannot be predicted by structural changes alone [19].…”

Section: Introductionmentioning

confidence: 99%

“…FDG-PET/CT has previously been correlated with carotid artery inflammation, which cannot be predicted by structural changes alone [19]. The uptake of [ 18 F] NaF is deemed clinically significant in atherosclerosis, acting as a potential prognostic marker for cardiovascular events linked to microcalcification, such as myocardial infarction, angina, and coronary artery disease [20]. Elucidating the relationship between [ 18 F] NaF uptake and arterial calcification could provide valuable insights for clinicians, informing their assessment of cardiovascular risk.…”

Section: Introductionmentioning

confidence: 99%

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Bilateral Carotid Artery Molecular Calcification Assessed by [18F] Fluoride PET/CT: Correlation with Cardiovascular and Thromboembolic Risk Factors

Patil,

Teichner,

Subtirelu

et al. 2023

Life

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Atherosclerosis, a leading cause of mortality and morbidity worldwide, involves inflammatory processes that result in plaque formation and calcification. The early detection of the molecular changes underlying these processes is crucial for effective disease management. This study utilized positron emission tomography/computed tomography (PET/CT) with [18F] sodium fluoride (NaF) as a tracer to visualize active calcification and inflammation at the molecular level. Our aim was to investigate the association between cardiovascular risk factors and [18F] NaF uptake in the left and right common carotid arteries (LCC and RCC). A cohort of 102 subjects, comprising both at-risk individuals and healthy controls, underwent [18F] NaF PET/CT imaging. The results revealed significant correlations between [18F] NaF uptake and cardiovascular risk factors such as age (β = 0.005, 95% CI 0.003–0.008, p < 0.01 in LCC and β = 0.006, 95% CI 0.004–0.009, p < 0.01 in RCC), male gender (β = −0.08, 95% CI −0.173–−0.002, p = 0.04 in LCC and β = −0.13, 95% CI −0.21–−0.06, p < 0.01 in RCC), BMI (β = 0.02, 95% CI 0.01–0.03, p < 0.01 in LCC and β = 0.02, 95% CI 0.01–0.03, p < 0.01 in RCC), fibrinogen (β = 0.006, 95% CI 0.0009–0.01, p = 0.02 in LCC and β = 0.005, 95% CI 0.001–0.01, p = 0.01), HDL cholesterol (β = 0.13, 95% CI 0.04–0.21, p < 0.01 in RCC only), and CRP (β = −0.01, 95% CI −0.02–0.001, p = 0.03 in RCC only). Subjects at risk showed a higher [18F] NaF uptake compared to healthy controls (one-way ANOVA; p = 0.02 in LCC and p = 0.04 in RCC), and uptake increased with estimated cardiovascular risk (one-way ANOVA, p < 0.01 in LCC only). These findings underscore the potential of [18F] NaF PET/CT as a sensitive tool for the early detection of atherosclerotic plaque, assessment of cardiovascular risk, and monitoring of disease progression. Further research is needed to validate the technique’s predictive value and its potential impact on clinical outcomes.

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“…In CKD, 18 F-fluoride activity correlates strongly with bone histomorphometric parameters of skeletal remodeling, with very good diagnostic accuracy for high and low bone turnover [ 144–146 ]. Of interest, 18 F-NaF-PET also identifies sites of active vascular calcification, [ 147 ] and may detect early vascular lesions before arterial wall calcifications can be visualized by CT [ 148 ]. By providing simultaneous assessment of active vascular calcification and skeletal remodeling, 18 F-NaF-PET could offer exciting research possibilities in the field of CKD-MBD.…”

Section: Research Recommendationsmentioning

confidence: 99%

Ten tips on how to assess bone health in patients with chronic kidney disease

Jørgensen,

Lloret,

Lalayiannis

et al. 2024

Clinical Kidney Journal

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Patients with chronic kidney disease (CKD) experience a several-fold increased risk of fracture. Despite the high incidence and the associated excess morbidity and premature mortality, bone fragility in CKD, or CKD-associated osteoporosis, remains a blind spot in nephrology with an immense treatment gap. Defining the bone phenotype is a prerequisite for the appropriate therapy of CKD-associated osteoporosis at the patient level. In the present review, we suggest ten practical ‘tips and tricks’ for the assessment of bone health in patients with CKD. We describe the clinical, biochemical, and radiological evaluation of bone health, alongside the benefits and limitations of the available diagnostics. A bone biopsy, although the gold standard for diagnosing renal bone disease, is invasive and not widely available; though useful in complex cases, we do not consider it an essential component of bone assessment in patients with CKD-associated osteoporosis. Furthermore, we advocate for the deployment of multi-disciplinary expert teams at local, national, and potentially international level. Finally, we address the knowledge gap in the diagnosis, particularly early detection, appropriate ‘real-time’ monitoring of bone health in this highly vulnerable population, and emerging diagnostic tools, currently primarily used in research, that may be on the horizon of clinical practice.

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NaF-PET Imaging of Atherosclerosis Burden

Cited by 4 publications

References 69 publications

The Emerging Role of NaF-PET/CT in Detecting Vascular Microcalcification in the Pathogenesis of Neurological Dysfunction

The Emerging Role of NaF-PET/CT in Detecting Vascular Microcalcification in the Pathogenesis of Neurological Dysfunction

Bilateral Carotid Artery Molecular Calcification Assessed by [18F] Fluoride PET/CT: Correlation with Cardiovascular and Thromboembolic Risk Factors

Ten tips on how to assess bone health in patients with chronic kidney disease

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