Quantification of temporal changes in calcium score in active atherosclerotic plaque in major vessels by 18F-sodium fluoride PET/CT

Abstract

F-NaF uptake has a strong correlation with calcium score progression which was a predictor of future cardiovascular disease risk. PET/CT using F-NaF may be able to predict calcium score progression which is known to be the major characteristic of atherosclerosis.

Evolution of arterial [18F]-sodium fluoride uptake and calcification

“…13 The study by Nakahara et al 12 also reported a correlation between [ 18 F]-NaF uptake at baseline and the increase in calcification volume. These data validate the finding by Ishiwata et al 14 which reported a strong correlation between [ 18 F]-NaF uptake and calcium volume increase of primarily aortic plaques, over a period of approximatively 1 year. Of note, several other studies reported a similar observation, [15][16][17] while a retrospective study in a population with low incidence of calcification and with a longer follow-up period did not find a similar correlation.…”

“…22 The association between diffuse calcification and [ 18 F]-NaF uptake remains unclear, with some reports of positive, 11,15 negative 16 or absence of association. 8,10,14,17,18 A portion of this variability between the studies may be explained by the differences in methodology. While not presenting a direct correlation, Nakahara et al 12 showed that the maximal [ 18 F]-NaF uptake during the follow-up correlated with the calcium volume at the end of the study.…”

Atherosclerosis imaging with 18F-sodium fluoride PET: state-of-the-art review

“…Eight papers dealt exclusively with the coronary arteries [9][10][11][12][13][14][15][16] and seven solely with the carotid arteries [5,[17][18][19][20][21][22], while only one article focused on the thoracic aorta [23], the infrarenal aorta [24], and the femoral arteries [25]. Four studies were looking on the whole heart and aorta [26][27][28][29], whereas the remaining 11 articles focused also on more than one part of the cardio-arterial system, i.e., coronaries, carotids, and aorta [30][31][32]; coronaries, aorta, and femoral arteries [33]; coronaries and carotids [34]; carotid, aorta, iliac, and femoral arteries [4,35]; carotid, aorta, femoral arteries [36]; carotid, aorta, iliac [37]; carotid, subclavian, iliac, whole aorta [38]; and, finally, aorta and iliac arteries [39].…”

“…A few studies compared initial NaF imaging results with clinical findings at 1-2 years of follow-up, but did not repeat NaF-PET/CT imaging. They reported higher NaF uptake in non-calcified than calcified plaques at baseline and that initial NaF uptake did not correlate with CTcalcification measured in HU or volume a year later [37,39]. NaF uptake increases with age, the more so in patients, but with a wide scatter.…”

“…Novel CT macrocalcification was observed after a mean of 1446 days in 19/96 of original NaF hot spots without macrocalcifiation. Unfortunately, only CT and not NaF imaging was repeated [39]. This was done in a recent study by Li X et al who analyzed 19 out of 34 multiple myeloma patients (aged 68 ± 9 years, 8 women), who underwent both FDG and NaF imaging at an interval of 15 ± 4 months without in between intervention or important change in medication.…”