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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

European Journal of Nuclear Medicine and Molecular Imaging, ISSN: 1619-7089, Vol: 45, Issue: 12, Page: 2181-2189
2018
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Article Description

Objectives: The aim of this study was to evaluate the F-sodium fluoride (F-NaF) coronary uptake compared to coronary intravascular ultrasound (IVUS) in patients with symptomatic coronary artery disease. Background: 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. Methods: 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 F-NaF PET/CT and IVUS within 2 days. F-NaF maximum tissue-to-blood ratios (TBR) were calculated for 69 coronary plaques and correlated with IVUS plaque classification. Results: Significantly increased F-NaF uptake ratios were observed in fibrocalcific lesions (meanTBR = 1.42 ± 0.28), thin-cap atheroma with spotty calcifications (meanTBR = 1.32 ± 0.23), and thick-cap mixed atheroma (meanTBR = 1.28 ± 0.38), while fibrotic plaques showed no increased uptake (meanTBR = 0.96 ± 0.18). The F-NaF uptake ratio was consistently higher in atherosclerotic lesions with severe calcification (meanTBR = 1.34 ± 0.22). The regional F-NaF uptake was most likely localized in the border region of intensive calcification. Coronary lesions with positive F-NaF uptake showed some increased high-risk anatomical features on IVUS in comparison to 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 F-NaF lesions. Conclusions: 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.

Bibliographic Details

Li, Li; Li, Xiang; Jia, Yongping; Fan, Jiamao; Wang, Huifeng; Fan, Chunyu; Wu, Lei; Si, Xincheng; Hao, Xinzhong; Wu, Ping; Yan, Min; Wang, Ruonan; Hu, Guang; Liu, Jianzhong; Wu, Zhifang; Hacker, Marcus; Li, Sijin

Springer Science and Business Media LLC

Medicine

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