What can be and what cannot be accomplished with PET to detect and characterize atherosclerotic plaques

Atherosclerosis Imaging with 18F-Sodium Fluoride PET

“…Most centers calculated a TBR using SUVmax and/or SUVmean values divided by blood pool activity from various parts of the vascular bed, even if recorded activity varies considerably from segment to segment of the vascular bed dependent on spill-over from NaF content in adjacent bone [ 40 ]. Cardiac motion was addressed in particular by Kwiecinski et al, who measured the uptake in the proximal parts of the coronary arteries [ 41 , 42 ], which others have found to be suboptimal due to the limited spatial resolution of PET imaging and cardiac and respiratory movements [ 43 ]. Instead, a global assessment approach comprising the entire heart may be preferable [ 4 , 44 ], and perhaps a better reflection of cardiac atherosclerosis burden as a clinically more relevant measure than the NaF uptake in vulnerable coronary plaques [ 45 , 46 ].…”

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

“…The study is a good example of the potential of NaF-PET combined with CT angiography to track the effects of therapeutic intervention on focal NaF uptake to phenotype coronary plaque. The authors of this review consider measures of focal NaF uptake in the coronary arteries as very promising, but we urge caution, mainly because it is challenging to detect and measure by PET the NaF uptake in anything but the larger, most proximal parts of the coronary arteries [57,64], which may not be representative for the total cardiac atherosclerotic burden. Thus, we share the opinion of authors Arbab-Zadeh and Fuster that the atherosclerotic burden rather than the "vulnerable plague" should be the target of molecular atherosclerosis imaging [48,65,66].…”

Futility of attempts to detect and quantify beta cells by PET imaging in the pancreas: why it is time to abandon the approach

“…Recently, we have published several editorials to make the community aware of the issues that we face in applying PET in several important domains [6,7]. In particular, we have been very critical of approaches that utilise PET to detect normal structures or lesions that are very small in size and dispersed in organs with significant non-specific background activity.…”