Sodium-fluoride PET-CT for the non-invasive evaluation of coronary plaques in symptomatic patients with coronary artery disease: a cross-correlation study with intravascular ultrasound.
prospective_cohort · Level II
Where this comes from
- Record sourced from PubMed, PMID 30171271.
- Also identified by DOI 10.1007/s00259-018-4122-0 and PMC identifier 6182395.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
The aim of this study was to evaluate the <sup>18</sup>F-sodium fluoride (<sup>18</sup>F-NaF) coronary uptake compared to coronary intravascular ultrasound (IVUS) in patients with symptomatic coronary artery disease. <sup>18</sup>F-NaF PET enables the assessment of vascular osteogenesis by interaction with surface hydroxyapatite, while IVUS enables both identification and quantification of intra-plaque components. Forty-four patients with symptomatic coronary artery disease were included in this prospective controlled trial, 32 of them (30 patients with unstable angina and 2 patients with stable angina), representing the final study cohort, got additional IVUS. All patients underwent cardiac <sup>18</sup>F-NaF PET/CT and IVUS within 2 days. <sup>18</sup>F-NaF maximum tissue-to-blood ratios (TBR<sub>max</sub>) were calculated for 69 coronary plaques and correlated with IVUS plaque classification. Significantly increased <sup>18</sup>F-NaF uptake ratios were observed in fibrocalcific lesions (meanTBR<sub>max</sub> = 1.42 ± 0.28), thin-cap atheroma with spotty calcifications (meanTBR<sub>max</sub> = 1.32 ± 0.23), and thick-cap mixed atheroma (meanTBR<sub>max</sub> = 1.28 ± 0.38), while fibrotic plaques showed no increased uptake (meanTBR<sub>max</sub> = 0.96 ± 0.18). The <sup>18</sup>F-NaF uptake ratio was consistently higher in atherosclerotic lesions with severe calcification (meanTBR<sub>max</sub> = 1.34 ± 0.22). The regional <sup>18</sup>F-NaF uptake was most likely localized in the border region of intensive calcification. Coronary lesions with positive <sup>18</sup>F-NaF uptake showed some increased high-risk anatomical features on IVUS in comparison to <sup>18</sup>F-NaF negative plaques. It included a significant severe plaque burden (70.1 ± 13.8 vs. 61.0 ± 13.8, p = 0.01) and positive remodeling index (1.03 ± 0.08 vs. 0.99 ± 0.07, p = 0.05), as well as a higher percentage of necrotic tissue (37.6 ± 13.3 vs. 29.3 ± 15.7, p = 0.02) in positive <sup>18</sup>F-NaF lesions. <sup>18</sup>F-NaF coronary uptake may provide a molecular insight for the characterization of coronary atherosclerotic lesions. Specific regional uptake is needed to be determined by histology.
Medical subject headings
- Coronary Artery Disease
- Plaque, Atherosclerotic
- Positron Emission Tomography Computed Tomography
- Sodium Fluoride
- Ultrasonography, Interventional