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Lin L, Chen L, Yan J, Chen P, Du J, Zhu J, Yang X, Geng B, Li L, Zeng W. Advances of nanoparticle-mediated diagnostic and theranostic strategies for atherosclerosis. Front Bioeng Biotechnol 2023; 11:1268428. [PMID: 38026849 PMCID: PMC10666776 DOI: 10.3389/fbioe.2023.1268428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Atherosclerotic plaque remains the primary cause of morbidity and mortality worldwide. Accurate assessment of the degree of atherosclerotic plaque is critical for predicting the risk of atherosclerotic plaque and monitoring the results after intervention. Compared with traditional technology, the imaging technologies of nanoparticles have distinct advantages and great development prospects in the identification and characterization of vulnerable atherosclerotic plaque. Here, we systematically summarize the latest advances of targeted nanoparticle approaches in the diagnosis of atherosclerotic plaque, including multimodal imaging, fluorescence imaging, photoacoustic imaging, exosome diagnosis, and highlighted the theranostic progress as a new therapeutic strategy. Finally, we discuss the major challenges that need to be addressed for future development and clinical transformation.
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Affiliation(s)
- Lin Lin
- School of Medicine, Chongqing University, Chongqing, China
- Department of Cell Biology, Third Military Medical University, Chongqing, China
- Jinfeng Laboratory, Chongqing, China
| | - Lin Chen
- Department of Cell Biology, Third Military Medical University, Chongqing, China
| | - Juan Yan
- Department of Cell Biology, Third Military Medical University, Chongqing, China
- Jinfeng Laboratory, Chongqing, China
| | - Peirong Chen
- Department of Cell Biology, Third Military Medical University, Chongqing, China
| | - Jiahui Du
- Department of Cell Biology, Third Military Medical University, Chongqing, China
- Jinfeng Laboratory, Chongqing, China
| | - Junpeng Zhu
- Department of Cell Biology, Third Military Medical University, Chongqing, China
- Jinfeng Laboratory, Chongqing, China
| | - Xinyu Yang
- Department of Cell Biology, Third Military Medical University, Chongqing, China
- Jinfeng Laboratory, Chongqing, China
| | - Boxin Geng
- Department of Cell Biology, Third Military Medical University, Chongqing, China
- Jinfeng Laboratory, Chongqing, China
| | - Lang Li
- Department of Cell Biology, Third Military Medical University, Chongqing, China
- Jinfeng Laboratory, Chongqing, China
| | - Wen Zeng
- School of Medicine, Chongqing University, Chongqing, China
- Department of Cell Biology, Third Military Medical University, Chongqing, China
- Jinfeng Laboratory, Chongqing, China
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Immanuel J, Yun S. Vascular Inflammatory Diseases and Endothelial Phenotypes. Cells 2023; 12:1640. [PMID: 37371110 DOI: 10.3390/cells12121640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The physiological functions of endothelial cells control vascular tone, permeability, inflammation, and angiogenesis, which significantly help to maintain a healthy vascular system. Several cardiovascular diseases are characterized by endothelial cell activation or dysfunction triggered by external stimuli such as disturbed flow, hypoxia, growth factors, and cytokines in response to high levels of low-density lipoprotein and cholesterol, hypertension, diabetes, aging, drugs, and smoking. Increasing evidence suggests that uncontrolled proinflammatory signaling and further alteration in endothelial cell phenotypes such as barrier disruption, increased permeability, endothelial to mesenchymal transition (EndMT), and metabolic reprogramming further induce vascular diseases, and multiple studies are focusing on finding the pathways and mechanisms involved in it. This review highlights the main proinflammatory stimuli and their effects on endothelial cell function. In order to provide a rational direction for future research, we also compiled the most recent data regarding the impact of endothelial cell dysfunction on vascular diseases and potential targets that impede the pathogenic process.
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Affiliation(s)
- Jenita Immanuel
- Department of Biotechnology, Inje University, Gimhae-si 50834, Republic of Korea
| | - Sanguk Yun
- Department of Biotechnology, Inje University, Gimhae-si 50834, Republic of Korea
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Abstract
The use of positron emission tomography imaging with 18F-fluorodeoxyglucose in the diagnostic workup of patients with suspected prosthetic valve endocarditis and cardiac device infection (implantable electronic device and left ventricular assist device) is gaining momentum in clinical practice. However, in the absence of prospective randomized trials, guideline recommendations about 18F-fluorodeoxyglucose positron emission tomography in this setting are currently largely based on expert opinion. Measurement of aortic valve microcalcification occurring as a healing response to valvular inflammation using 18F-sodium fluoride positron emission tomography represents another promising clinical approach, which is associated with both the risk of native valve stenosis progression and bioprosthetic valve degeneration in research trials. In this review, we consider the role of molecular imaging in cardiac valvular diseases, including aortic stenosis and valvular endocarditis, as well as cardiac device infections.
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Affiliation(s)
- Jason M Tarkin
- Heart and Lung Research Institute, University of Cambridge, UK (J.M.T.)
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, MD (W.C., V.D.)
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, UK (M.R.D.)
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, MD (W.C., V.D.)
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Park S, Chung WB, O JH, Lee KY, Jung MH, Jung HO, Chang K, Youn HJ. Trans-Aortic Flow Turbulence and Aortic Valve Inflammation: A Pilot Study Using Blood Speckle Imaging and 18F-Sodium Fluoride Positron Emission Tomography/Computed Tomography in Patients With Moderate Aortic Stenosis. J Cardiovasc Imaging 2023. [PMID: 37488920 PMCID: PMC10374388 DOI: 10.4250/jcvi.2022.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND 18F-sodium fluoride positron emission tomography/computed tomography (18F-NaF PET/CT) has been proven to be useful in identification of microcalcifications, which are stimulated by inflammation. Blood speckle imaging (BSI) is a new imaging technology used for tracking the flow of blood cells using transesophageal echocardiography (TEE). We evaluated the relationship between turbulent flow identified by BSI and inflammatory activity of the aortic valve (AV) as indicated by the 18F-NaF uptake index in moderate aortic stenosis (AS) patients. METHODS This study enrolled 18 moderate AS patients diagnosed within the past 6 months. BSI within the aortic root was acquired using long-axis view TEE. The duration of laminar flow and the turbulent flow area ratio were calculated by BSI to demonstrate the degree of turbulence. The maximum and mean standardized uptake values (SUVmax, SUVmean) and the total microcalcification burden (TMB) as measured by 18F-NaF PET/CT were used to demonstrate the degree of inflammatory activity in the AV region. RESULTS The mean SUVmean, SUVmax, and TMB were 1.90 ± 0.79, 2.60 ± 0.98, and 4.20 ± 2.18 mL, respectively. The mean laminar flow period and the turbulent area ratio were 116.1 ± 61.5 msec and 0.48 ± 0.32. The correlation between SUVmax and turbulent flow area ratio showed the most positive and statistically significant correlation, with a Pearson's correlation coefficient (R²) of 0.658 and a p-value of 0.014. CONCLUSIONS The high degree of trans-aortic turbulence measured by BSI was correlated with severe AV inflammation.
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Dai M, Xu W, Chesnais H, Anabaraonye N, Parente J, Chatterjee S, Rajapakse CS. Atherogenic Indices as a Predictor of Aortic Calcification in Prostate Cancer Patients Assessed Using 18F-Sodium Fluoride PET/CT. Int J Mol Sci 2022; 23:13056. [PMID: 36361839 PMCID: PMC9653585 DOI: 10.3390/ijms232113056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
A major pathophysiological cause of cardiovascular disease is vascular plaque calcification. Fluorine 18−Sodium Fluoride (18F-NaF) PET/CT can be used as a sensitive imaging modality for detection of vascular calcification. The aim of this study was to find a non-invasive, cost-efficient, and readily available metric for predicting vascular calcification severity. This retrospective study was performed on 36 participants who underwent 18F-NaF fused PET/CT scans. The mean standard uptake values (SUVs) were calculated from manually sectioned axial sections over the aortic arch and thoracic aorta. Correlation analyses were performed between SUVs and calculated atherogenic indices (AIs). Castelli’s Risk Index I (r = 0.63, p < 0.0001), Castelli’s Risk Index II (r = 0.64, p < 0.0001), Atherogenic Coefficient (r = 0.63, p < 0.0001), Atherogenic Index of Plasma (r = 0.51, p = 0.00152), and standalone high-density lipoprotein (HDL) cholesterol (r = −0.53, p = 0.000786) were associated with aortic calcification. AIs show strong association with aortic arch and thoracic aorta calcifications. AIs are better predictors of vascular calcification compared to standalone lipid metrics, with the exception of HDL cholesterol. Clinical application of AIs provides a holistic metric beneficial for enhancing screening and treatment protocols.
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Affiliation(s)
- Michelle Dai
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
- College of Osteopathic Medicine, Touro University Nevada, 874 American Pacific Drive, Henderson, NV 89014, USA
| | - Winnie Xu
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Helene Chesnais
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Nancy Anabaraonye
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - James Parente
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Shampa Chatterjee
- Department of Physiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chamith S. Rajapakse
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
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Borges-Rosa J, Oliveira-Santos M, Silva R, da Silva NP, Abrunhosa A, Castelo-Branco M, Gonçalves L, Ferreira MJ. Cardiac microcalcification burden: Global assessment in high cardiovascular risk subjects with Na[ 18F]F PET-CT. J Nucl Cardiol 2022; 29:1846-1854. [PMID: 33826127 DOI: 10.1007/s12350-021-02600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fluorine-18 sodium fluoride (Na[18F]F) atherosclerotic plaque uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification. We aim to evaluate global cardiac microcalcification activity with Na[18F]F, as a measure of unstable microcalcification burden, in high cardiovascular (CV) risk patients. METHODS AND RESULTS Thirty-four high CV risk individuals without previous CV events were scanned with Na[18F]F PET-CT. Cardiac Na[18F]F uptake was assessed through the global molecular calcium score (GMCS), which was calculated by summing the product of the mean standardized uptake value times the area of the cardiac regions of interest times the slice thickness for all cardiac transaxial slices, divided by the total number of slices. Mean age is 63.5 ± 7.8 years and 62% male. Median GMCS is 320.9 (240.8-402.8). Individuals with more than five CV risk factors (50%) have increased GMCS [356.7 (321.0-409.6) vs. 261.1 (225.6-342.1), P = 0.01], which is positively correlated with predicted fatal CV risk by SCORE (rs = 0.32, P = 0.04). There is a positive correlation between GMCS and weight (rs = 0.61), body mass index (rs = 0.66), abdominal perimeter (rs = 0.74), thoracic fat volume (rs = 0.47), and epicardial adipose tissue (rs = 0.41), all with P ≤ 0.01. There is no correlation between GMCS and coronary calcium score nor coronary artery wall Na[18F]F uptake. CONCLUSIONS In a high CV risk group, the global cardiac microcalcification burden is related to CV risk factors, metabolic syndrome variables and cardiac fat. Cardiac GMCS is a promising risk stratification tool, combining a straightforward and objective methodology with a comprehensive analysis of both coronary and valvular microcalcification.
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Affiliation(s)
- João Borges-Rosa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Manuel Oliveira-Santos
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Rodolfo Silva
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Nuno Pereira da Silva
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Antero Abrunhosa
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Maria João Ferreira
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
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[18F]Sodium Fluoride PET has the potential to identify active formation of calcinosis cutis in limited cutaneous systemic sclerosis. Semin Arthritis Rheum 2022; 55:152027. [DOI: 10.1016/j.semarthrit.2022.152027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 12/12/2022]
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Dilsizian V, Budde RPJ, Chen W, Mankad SV, Lindner JR, Nieman K. Best Practices for Imaging Cardiac Device-Related Infections and Endocarditis: A JACC: Cardiovascular Imaging Expert Panel Statement. JACC Cardiovasc Imaging 2021; 15:891-911. [PMID: 34922877 DOI: 10.1016/j.jcmg.2021.09.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
The diagnosis of cardiac device infection and, more importantly, accurate localization of the infection site, such as defibrillator pocket, pacemaker lead, along the peripheral driveline or central portion of the left ventricular assist device, prosthetic valve ring abscesses, and perivalvular extensions, remain clinically challenging. Although transthoracic and transesophageal echocardiography are the first-line imaging tests in suspected endocarditis and for assessing hemodynamic complications, recent studies suggest that cardiac computed tomography (CT) or CT angiography and functional imaging with 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) with CT (FDG PET/CT) may have an incremental role in technically limited or inconclusive cases on echocardiography. One of the key benefits of FDG PET/CT is in its detection of inflammatory cells early in the infection process, before morphological damages ensue. However, there are many unanswered questions in the literature. In this document, we provide consensus on best practices among the various imaging studies, which includes the detection of cardiac device infection, differentiation of infection from inflammation, image-guided patient management, and detailed recommendations on patient preparation, image acquisition, processing, interpretation, and standardized reporting.
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Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute and the Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Koen Nieman
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
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Atorvastatin Promotes Macrocalcification, But Not Microcalcification in Atherosclerotic Rabbits: An 18F-NaF PET/CT Study. J Cardiovasc Pharmacol 2021; 78:544-550. [PMID: 34651601 DOI: 10.1097/fjc.0000000000001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/29/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Our study aimed to investigate the effect of atorvastatin on plaque calcification by matching the results obtained by 18F-sodium fluoride (18F-NaF) positron emission tomography (PET)/computed tomography (CT) with data from histologic sections. METHODS AND RESULTS The rabbits were divided into 2 groups as follows: an atherosclerosis group (n = 10) and an atorvastatin group (n = 10). All rabbits underwent an abdominal aortic operation and were fed a high-fat diet to induce atherosclerosis. Plasma samples were used to analyze serum inflammation markers and blood lipid levels. 18F-NaF PET/CT scans were performed twice. The plaque area, macrophage number and calcification were measured, and the data from the pathological sections were matched with the 18F-NaF PET/CT scan results. The mean standardized uptake value (0.725 ± 0.126 vs. 0.603 ± 0.071, P < 0.001) and maximum standardized uptake value (1.024 ± 0.116 vs. 0.854 ± 0.091, P < 0.001) significantly increased in the atherosclerosis group, but only slightly increased in the atorvastatin group (0.616 ± 0.103 vs. 0.613 ± 0.094, P = 0.384; 0.853 ± 0.099 vs.0.837 ± 0.089, P < 0.001, respectively). The total calcium density was significantly increased in rabbits treated with atorvastatin compared with rabbits not treated with atorvastatin (1.64 ± 0.90 vs. 0.49 ± 0.35, P < 0.001), but the microcalcification level was significantly lower. There were more microcalcification deposits in the areas with increased radioactive uptake of 18F-NaF. CONCLUSIONS Our study suggests that the anti-inflammatory activity of atorvastatin may promote macrocalcification but not microcalcification within atherosclerotic plaques. 18F-NaF PET/CT can detect plaque microcalcifications.
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Ahmed M, McPherson R, Abruzzo A, Thomas SE, Gorantla VR. Carotid Artery Calcification: What We Know So Far. Cureus 2021; 13:e18938. [PMID: 34815892 PMCID: PMC8605497 DOI: 10.7759/cureus.18938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 12/27/2022] Open
Abstract
Carotid artery calcification (CAC) is a well-known marker of atherosclerosis and is linked to a high rate of morbidity and mortality. CAC is divided into two types: intimal and medial calcifications, each with its own set of risk factors. Vascular calcification is now understood to be an active, enzymatically regulated process involving dystrophic calcification and endothelial dysfunction at an early stage. This causes a pathogenic inflammatory response, resulting in calcium phosphate deposition in the form of microcalcifications, which causes plaque formation, ultimately becoming unstable with sequelae of complications. If the inflammation goes away, hydroxyapatite crystal formation takes over, resulting in macro-calcifications that help to keep the plaque stable. As CAC can be asymptomatic, it is critical to identify it early using diagnostic imaging. The carotid artery calcification score is calculated using computed tomography angiography (CTA), which is a confirmatory test that enables the examination of plaque composition and computation of the carotid artery calcification score. Magnetic resonance angiography (MRA), which is sensitive as CTA, duplex ultrasound (DUS), positron emission tomography, and computed tomography (PET-CT) imaging with (18) F-Sodium Fluoride, and Optical Coherence Tomography (OCT) are some of the other diagnostic imaging modalities used. The current therapeutic method starts with the best medical care and is advised for all CAC patients. Carotid endarterectomy and carotid stenting are two treatment options that have mixed results in terms of effectiveness and safety. When patient age and anatomy, operator expertise, and surgical risk are all considered, the agreement is that both techniques are equally beneficial.
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Affiliation(s)
- Madeeha Ahmed
- Family Medicine, American University of Antigua College of Medicine, Antigua, ATG
| | - Regina McPherson
- Anatomical Sciences, American University of Antigua, St.John's, ATG
| | - Alexandra Abruzzo
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Sneha E Thomas
- Internal Medicine, University of Maryland Medical Center, Baltimore, USA
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Advances in Quantitative Analysis of 18F-Sodium Fluoride Coronary Imaging. Mol Imaging 2021; 2021:8849429. [PMID: 33746631 PMCID: PMC7953548 DOI: 10.1155/2021/8849429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/05/2020] [Indexed: 11/22/2022] Open
Abstract
18F-sodium fluoride (18F-NaF) positron emission tomography (PET) has emerged as a promising noninvasive imaging tool for the assessment of active calcification processes in coronary artery disease. 18F-NaF uptake colocalizes to high-risk and ruptured atherosclerotic plaques. Most recently, 18F-NaF coronary uptake was shown to be a robust and independent predictor of myocardial infarction in patients with advanced coronary artery disease. In this review, we provide an overview of the advances in coronary 18F-NaF imaging. In particular, we discuss the recently developed and validated motion correction techniques which address heart contractions, tidal breathing, and patient repositioning during the prolonged PET acquisitions. Additionally, we discuss a novel quantification approach—the coronary microcalcification activity (which has been inspired by the widely employed method in oncology total active tumor volume measurement). This new method provides a single number encompassing 18F-NaF activity within the entire coronary vasculature rather than just information regarding a single area of most intense tracer uptake.
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Xu L, Wang R, Liu H, Wang J, Liang W, Mang J, Xu Z. Comparison of the Diagnostic Performances of Ultrasound, High-Resolution Magnetic Resonance Imaging, and Positron Emission Tomography/Computed Tomography in a Rabbit Carotid Vulnerable Plaque Atherosclerosis Model. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2201-2209. [PMID: 32395879 DOI: 10.1002/jum.15331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/25/2020] [Accepted: 04/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Our study aimed to evaluate the diagnostic performances of 3 routine examination methods for cerebrovascular disease in a rabbit carotid artery atherosclerosis model. METHODS A total of 12 New Zealand rabbits were included: 4 in a control group and 8 in an experimental group. A clinically relevant atherosclerosis rabbit model was induced by left common carotid artery ligation and a 12-week high-fat diet. Atherosclerosis was further confirmed by a histopathologic analysis. Then carotid ultrasound (US) imaging, high-resolution magnetic resonance imaging (HRMRI), and positron emission tomography (PET)/computed tomography (CT) were performed on this model to evaluate the diagnostic performances. RESULTS Carotid US showed plaque formation in the left common carotid artery and little plaque in the right common carotid artery in the experimental group. In addition, HRMRI showed stenosis formation in the left common carotid artery in the experimental group. At the horizontal level, plaques were found in the left common carotid artery, and no plaques were found in the right common carotid artery in the experimental group. Also, PET/CT showed local hypermetabolism and vulnerable plaques in the left common carotid artery of the experimental group, whereas no hypermetabolism was found in the right common carotid artery of the experimental group. Moreover, the soft plaques detected by carotid US were different from the vulnerable plaques detected by PET/CT. The unstable plaques on HRMRI were the same as the hypermetabolic vulnerable plaques on PET/CT. CONCLUSIONS High-resolution MRI is recommended for the evaluation of neck and intracranial vascular stenosis and plaque properties in patients with stroke.
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Affiliation(s)
- Lei Xu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Renjie Wang
- Department Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hongyu Liu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jiaoqi Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wenzhao Liang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jing Mang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhongxin Xu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
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Ammirati E, Moroni F, Magnoni M, Rocca MA, Messina R, Anzalone N, De Filippis C, Scotti I, Besana F, Spagnolo P, Rimoldi OE, Chiesa R, Falini A, Filippi M, Camici PG. Extent and characteristics of carotid plaques and brain parenchymal loss in asymptomatic patients with no indication for revascularization. IJC HEART & VASCULATURE 2020; 30:100619. [PMID: 32904369 PMCID: PMC7452655 DOI: 10.1016/j.ijcha.2020.100619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/01/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Extent of subclinical atherosclerosis has been associated with brain parenchymal loss in community-dwelling aged subjects. Identification of patient-related and plaque-related markers could identify subjects at higher risk of brain atrophy, independent of cerebrovascular accidents. Aim of the study was to investigate the relation between extent and characteristics of carotid plaques and brain atrophy in asymptomatic patients with no indication for revascularization. METHODS AND RESULTS Sixty-four patients (aged 69 ± 8 years, 45% females) with carotid stenosis <70% based on Doppler flow velocity were enrolled in the study. Potential causes of cerebral damage other than atherosclerosis, including history of atrial fibrillation, heart failure, previous cardiac or neurosurgery and neurological disorders were excluded. All subjects underwent carotid computed tomography angiography, contrast enhanced ultrasound for assessment of plaque neovascularization and brain magnetic resonance imaging for measuring brain volumes. On multivariate regression analysis, age and fibrocalcific plaques were independently associated with lower total brain volumes (β = -3.13 and β = -30.7, both p < 0.05). Fibrocalcific plaques were also independently associated with lower gray matter (GM) volumes (β = -28.6, p = 0.003). On the other hand, age and extent of carotid atherosclerosis were independent predictors of lower white matter (WM) volumes. CONCLUSIONS WM and GM have different susceptibility to processes involved in parenchymal loss. Contrary to common belief, our results show that presence of fibrocalcific plaques is associated with brain atrophy.
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Affiliation(s)
- Enrico Ammirati
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
- De Gasperis Cardio Center, Niguarda Ca’ Granda Hospital, Milan, Italy
| | | | - Marco Magnoni
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Maria A Rocca
- Vita-Salute University and Neuroimaging Research Unit, Institute of Experimental Neurology, and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Messina
- Vita-Salute University and Neuroimaging Research Unit, Institute of Experimental Neurology, and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Nicoletta Anzalone
- Vita-Salute University and Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Costantino De Filippis
- Vita-Salute University and Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Isabella Scotti
- Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - Francesca Besana
- Cardiovascular Prevention Center, San Raffaele Institute, Milan, Italy
| | - Pietro Spagnolo
- Cardiovascular Prevention Center, San Raffaele Institute, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Roberto Chiesa
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Andrea Falini
- Vita-Salute University and Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Vita-Salute University and Neuroimaging Research Unit, Institute of Experimental Neurology, and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo G Camici
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
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14
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Pelletier-Galarneau M, Abikhzer G, Harel F, Dilsizian V. Detection of Native and Prosthetic Valve Endocarditis: Incremental Attributes of Functional FDG PET/CT over Morphologic Imaging. Curr Cardiol Rep 2020; 22:93. [PMID: 32647931 DOI: 10.1007/s11886-020-01334-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The clinical and incremental value of functional imaging with 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) for the diagnosis and management of patients with suspected native and prosthetic valve infective endocarditis (IE). RECENT FINDINGS The diagnosis of IE is challenging because of the highly variable clinical presentations, especially in the case of prosthetic valve endocarditis (PVE). FDG PET/CT has been shown to play an important role for the diagnosis of PVE as a major Duke criterion. Whether FDG PET/CT could play a similar role in patients with suspected native valve endocarditis (NVE) is less well established. It is increasingly recognized that IE is a multisystem disorder, and identification of extra-cardiac manifestations on whole-body FDG PET/CT impacts management and prognosis of patients with IE. Finally, FDG PET/CT provides incremental prognostic value over other clinical and para-clinical parameters, enabling prediction of in-hospital mortality, IE recurrence, hospitalization, and new onset heart failure and embolic events. FDG PET/CT plays a key role in the investigation of patients with suspected IE, enabling detection of valvular infection and extra-cardiac manifestations of the infection which has important prognostic implications.
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Affiliation(s)
- Matthieu Pelletier-Galarneau
- Department of Medical Imaging, Institut de Cardiologie de Montréal, Université de Montréal, 5000 Bélanger, Montréal, Québec, H1T1C8, Canada. .,Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gad Abikhzer
- Department of Medical Imaging, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Francois Harel
- Department of Medical Imaging, Institut de Cardiologie de Montréal, Université de Montréal, 5000 Bélanger, Montréal, Québec, H1T1C8, Canada
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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15
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MacAskill MG, Newby DE, Tavares AAS. Frontiers in positron emission tomography imaging of the vulnerable atherosclerotic plaque. Cardiovasc Res 2020; 115:1952-1962. [PMID: 31233100 DOI: 10.1093/cvr/cvz162] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/16/2019] [Accepted: 06/19/2019] [Indexed: 02/07/2023] Open
Abstract
Rupture of vulnerable atherosclerotic plaques leading to an atherothrombotic event is the primary driver of myocardial infarction and stroke. The ability to detect non-invasively the presence and evolution of vulnerable plaques could have a huge impact on the future identification and management of atherosclerotic cardiovascular disease. Positron emission tomography (PET) imaging with an appropriate radiotracer has the potential to achieve this goal. This review will discuss the biological hallmarks of plaque vulnerability before going on to evaluate and to present PET imaging approaches which target these processes. The focus of this review will be on techniques beyond [18F]FDG imaging, some of which are clinically advanced, and others which are on the horizon. As inflammation is the primary driving force behind atherosclerotic plaque development, we will predominantly focus on approaches which either directly, or indirectly, target this process.
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Affiliation(s)
- Mark G MacAskill
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Adriana A S Tavares
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
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16
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Abstract
The pineal gland is an endocrine gland whose main function is the biosynthesis and secretion of melatonin, a hormone responsible for regulating circadian rhythms, e.g., the sleep/wake cycle. Due to its exceptionally high vascularization and its location outside the blood–brain barrier, the pineal gland may accumulate significant amounts of calcium and fluoride, making it the most fluoride-saturated organ of the human body. Both the calcification and accumulation of fluoride may result in melatonin deficiency.
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17
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Evans NR, Tarkin JM, Chowdhury MM, Le EPV, Coughlin PA, Rudd JHF, Warburton EA. Dual-Tracer Positron-Emission Tomography for Identification of Culprit Carotid Plaques and Pathophysiology In Vivo. Circ Cardiovasc Imaging 2020; 13:e009539. [PMID: 32164454 DOI: 10.1161/circimaging.119.009539] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inflammation and microcalcification are interrelated processes contributing to atherosclerotic plaque vulnerability. Positron-emission tomography can quantify these processes in vivo. This study investigates (1) 18F-fluorodeoxyglucose (FDG) and 18F-sodium fluoride (NaF) uptake in culprit versus nonculprit carotid atheroma, (2) spatial distributions of uptake, and (3) how macrocalcification affects this relationship. METHODS Individuals with acute ischemic stroke with ipsilateral carotid stenosis of ≥50% underwent FDG-positron-emission tomography and NaF-positron-emission tomography. Tracer uptake was quantified using maximum tissue-to-background ratios (TBRmax) and macrocalcification quantified using Agatston scoring. RESULTS In 26 individuals, median most diseased segment TBRmax (interquartile range) was higher in culprit than in nonculprit atheroma for both FDG (2.08 [0.52] versus 1.89 [0.40]; P<0.001) and NaF (2.68 [0.63] versus 2.39 [1.02]; P<0.001). However, whole vessel TBRmax was higher in culprit arteries for FDG (1.92 [0.41] versus 1.71 [0.31]; P<0.001) but not NaF (1.85 [0.28] versus 1.79 [0.60]; P=0.10). NaF uptake was concentrated at carotid bifurcations, while FDG was distributed evenly throughout arteries. Correlations between FDG and NaF TBRmax differed between bifurcations with low macrocalcification (rs=0.38; P<0.001) versus high macrocalcification (rs=0.59; P<0.001). CONCLUSIONS This is the first study to demonstrate increased uptake of both FDG and NaF in culprit carotid plaques, with discrete distributions of pathophysiology influencing vulnerability in vivo. These findings have implications for our understanding of the natural history of the disease and for the clinical assessment and management of carotid atherosclerosis.
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Affiliation(s)
- Nicholas R Evans
- Department of Clinical Neurosciences (N.R.E., E.A.W.), University of Cambridge, Cambridge, United Kingdom.,Department of Medicine (N.R.E., J.M.T., E.P.V.L., J.H.F.R.), University of Cambridge, Cambridge, United Kingdom
| | - Jason M Tarkin
- Department of Medicine (N.R.E., J.M.T., E.P.V.L., J.H.F.R.), University of Cambridge, Cambridge, United Kingdom
| | - Mohammed M Chowdhury
- Division of Vascular Surgery (M.M.C., P.A.C.), University of Cambridge, Cambridge, United Kingdom
| | - Elizabeth P V Le
- Department of Medicine (N.R.E., J.M.T., E.P.V.L., J.H.F.R.), University of Cambridge, Cambridge, United Kingdom
| | - Patrick A Coughlin
- Division of Vascular Surgery (M.M.C., P.A.C.), University of Cambridge, Cambridge, United Kingdom
| | - James H F Rudd
- Department of Medicine (N.R.E., J.M.T., E.P.V.L., J.H.F.R.), University of Cambridge, Cambridge, United Kingdom
| | - Elizabeth A Warburton
- Department of Clinical Neurosciences (N.R.E., E.A.W.), University of Cambridge, Cambridge, United Kingdom
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18
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Guaraldi G, Milic J, Prandini N, Ligabue G, Esposito F, Ciusa G, Malagoli A, Scaglioni R, Besutti G, Beghetto B, Nardini G, Roncaglia E, Mussini C, Raggi P. 18Fluoride-based molecular imaging of coronary atherosclerosis in HIV infected patients. Atherosclerosis 2020; 297:127-135. [PMID: 32113050 DOI: 10.1016/j.atherosclerosis.2020.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/18/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Molecular imaging with 18Fluorodeoxyglucose (FDG) and 18F-sodium-fluoride (NaF) captures arterial inflammation and micro-calcification and can reveal potentially unstable atherosclerotic plaques. METHODS We performed FDG and NaF PET/CT imaging in two clinically similar cohorts of patients living with HIV (PLWH) with no symptomatic cardiovascular disease. The prevalence and intensity of coronary artery uptake of each tracer, measured as target-to-background ratio (TBR), were assessed in patients at low and high cardiovascular risk. RESULTS Ninety-three PLWH were submitted to PET/CT imaging with FDG (N = 43) and NaF (N = 50); 42% were at low and 58% at high cardiovascular risk. The intensity of uptake and multivessel coronary artery uptake were significantly higher with NaF than FDG both in low and high-risk patients. When each 18F-tracer was tested in low and high-risk patients, an equal proportion of subjects showed no vessel, single and multivessel NaF uptake; the same was true for no and single vessel uptake of FDG (no multivessel FDG uptake was noted). Waist circumference, CRP, D-dimer, HIV duration and treatment with nucleoside reverse transcriptase inhibitors were associated with high NaF uptake in univariable analyses; D-dimer remained significant in multivariable analyses (OR = 1.05; p=0.02). There were no significant associations with FDG uptake. CONCLUSIONS The prevalence of coronary artery uptake was higher with NaF compared to FDG both in high and low risk patients, hence microcalcification imaging may be a more sensitive tool to detect coronary atherosclerosis than inflammation imaging. However, the uptake of each 18Fluoride tracer was similar between low and high-risk subjects, and this underscores the discordance between clinical and imaging based risk assessment. Future investigation should address the prognostic significance of NaF coronary artery uptake.
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Affiliation(s)
- Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Jovana Milic
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Napoleone Prandini
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Guido Ligabue
- Department of Radiology, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Francesco Esposito
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Giacomo Ciusa
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Andrea Malagoli
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Riccardo Scaglioni
- Department of Radiology, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Giulia Besutti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124, Modena, Italy; Department of Radiology, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Barbara Beghetto
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Giulia Nardini
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Enrica Roncaglia
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Cristina Mussini
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Paolo Raggi
- Division of Cardiology and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, 11220, 83rd Avenue, Suite 5A9-014, Edmonton, AB T6G 2B7, Canada.
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19
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Chen W, Dilsizian V. Molecular Imaging of Cardiovascular Device Infection: Targeting the Bacteria or the Host–Pathogen Immune Response? J Nucl Med 2020; 61:319-326. [DOI: 10.2967/jnumed.119.228304] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/22/2020] [Indexed: 12/14/2022] Open
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20
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Shi X, Gao J, Lv Q, Cai H, Wang F, Ye R, Liu X. Calcification in Atherosclerotic Plaque Vulnerability: Friend or Foe? Front Physiol 2020; 11:56. [PMID: 32116766 PMCID: PMC7013039 DOI: 10.3389/fphys.2020.00056] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/21/2020] [Indexed: 12/23/2022] Open
Abstract
Calcification is a clinical marker of atherosclerosis. This review focuses on recent findings on the association between calcification and plaque vulnerability. Calcified plaques have traditionally been regarded as stable atheromas, those causing stenosis may be more stable than non-calcified plaques. With the advances in intravascular imaging technology, the detection of the calcification and its surrounding plaque components have evolved. Microcalcifications and spotty calcifications represent an active stage of vascular calcification correlated with inflammation, whereas the degree of plaque calcification is strongly inversely related to macrophage infiltration. Asymptomatic patients have a higher content of plaque calcification than that in symptomatic patients. The effect of calcification might be biphasic. Plaque rupture has been shown to correlate positively with the number of spotty calcifications, and inversely with the number of large calcifications. There may be certain stages of calcium deposition that may be more atherogenic. Moreover, superficial calcifications are independently associated with plaque rupture and intraplaque hemorrhage, which may be due to the concentrated and asymmetrical distribution of biological stress in plaques. Conclusively, calcification of differential amounts, sizes, shapes, and positions may play differential roles in plaque homeostasis. The surrounding environments around the calcification within plaques also have impacts on plaque homeostasis. The interactive effects of these important factors of calcifications and plaques still await further study.
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Affiliation(s)
- Xuan Shi
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Gao
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Qiushi Lv
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Haodi Cai
- Department of Neurology, Jinling Hospital, Southeast University, Nanjing, China
| | - Fang Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruidong Ye
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
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21
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22
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Kwiecinski J, Slomka PJ, Dweck MR, Newby DE, Berman DS. Vulnerable plaque imaging using 18F-sodium fluoride positron emission tomography. Br J Radiol 2019; 93:20190797. [PMID: 31804143 DOI: 10.1259/bjr.20190797] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Positron emission tomography (PET) with 18F-sodium fluoride (18F-NaF) has emerged as a promising non-invasive imaging modality to identify high-risk and ruptured atherosclerotic plaques. By visualizing microcalcification, 18F-NaF PET holds clinical promise in refining how we evaluate coronary artery disease, shifting our focus from assessing disease burden to atherosclerosis activity. In this review, we provide an overview of studies that have utilized 18F-NaF PET for imaging atherosclerosis. We discuss the associations between traditional coronary artery disease measures (risk factors) and 18F-NaF plaque activity. We also present the data on the histological validation as well as show how 18F-NaF uptake is associated with plaque morphology on intravascular and CT imaging. Finally, we discuss the technical challenges associated with 18F-NaF coronary PET highlighting recent advances in this area.
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Affiliation(s)
- Jacek Kwiecinski
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, USA.,Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, USA
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Daniel S Berman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, USA
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23
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Høilund-Carlsen PF, Sturek M, Alavi A, Gerke O. Atherosclerosis imaging with 18F-sodium fluoride PET: state-of-the-art review. Eur J Nucl Med Mol Imaging 2019; 47:1538-1551. [PMID: 31773235 PMCID: PMC7188711 DOI: 10.1007/s00259-019-04603-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/05/2019] [Indexed: 12/30/2022]
Abstract
Purpose We examined the literature to elucidate the role of 18F-sodium fluoride (NaF)-PET in atherosclerosis. Methods Following a systematic search of PubMed/MEDLINE, Embase, and Cochrane Library included articles underwent subjective quality assessment with categories low, medium, and high. Of 2811 records, 1780 remained after removal of duplicates. Screening by title and abstract left 41 potentially eligible full-text articles, of which 8 (about the aortic valve (n = 1), PET/MRI feasibility (n = 1), aortic aneurysms (n = 1), or quantification methodology (n = 5)) were dismissed, leaving 33 published 2010–2012 (n = 6), 2013–2015 (n = 11), and 2016–2018 (n = 16) for analysis. Results They focused on coronary (n = 8), carotid (n = 7), and femoral arteries (n = 1), thoracic aorta (n = 1), and infrarenal aorta (n = 1). The remaining 15 studies examined more than one arterial segment. The literature was heterogeneous: few studies were designed to investigate atherosclerosis, 13 were retrospective, 9 applied both FDG and NaF as tracers, 24 NaF only. Subjective quality was low in one, medium in 13, and high in 19 studies. The literature indicates that NaF is a very specific tracer that mimics active arterial wall microcalcification, which is positively associated with cardiovascular risk. Arterial NaF uptake often presents before CT-calcification, tends to decrease with increasing density of CT-calcification, and appears, rather than FDG-avid foci, to progress to CT-calcification. It is mainly surface localized, increases with age with a wide scatter but without an obvious sex difference. NaF-avid microcalcification can occur in fatty streaks, but the degree of progression to CT-calcification is unknown. It remains unknown whether medical therapy influences microcalcification. The literature held no therapeutic or randomized controlled trials. Conclusion The literature was heterogeneous and with few clear cut messages. NaF-PET is a new approach to detect and quantify microcalcification in early-stage atherosclerosis. NaF uptake correlates with cardiovascular risk factors and appears to be a good measure of the body’s atherosclerotic burden, potentially suited also for assessment of anti-atherosclerotic therapy. Electronic supplementary material The online version of this article (10.1007/s00259-019-04603-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. .,Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Michael Sturek
- Department of Anatomy, Cell Biology, Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Abass Alavi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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24
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Creager MD, Hohl T, Hutcheson JD, Moss AJ, Schlotter F, Blaser MC, Park MA, Lee LH, Singh SA, Alcaide-Corral CJ, Tavares AAS, Newby DE, Kijewski MF, Aikawa M, Di Carli M, Dweck MR, Aikawa E. 18F-Fluoride Signal Amplification Identifies Microcalcifications Associated With Atherosclerotic Plaque Instability in Positron Emission Tomography/Computed Tomography Images. Circ Cardiovasc Imaging 2019; 12:e007835. [PMID: 30642216 DOI: 10.1161/circimaging.118.007835] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Microcalcifications in atherosclerotic plaques are destabilizing, predict adverse cardiovascular events, and are associated with increased morbidity and mortality.18F-fluoride positron emission tomography (PET)/computed tomography (CT) imaging has demonstrated promise as a useful clinical diagnostic tool in identifying high-risk plaques; however, there is confusion as to the underlying mechanism of signal amplification seen in PET-positive, CT-negative image regions. This study tested the hypothesis that 18F-fluoride PET/CT can identify early microcalcifications. METHODS 18F-fluoride signal amplification derived from microcalcifications was validated against near-infrared fluorescence molecular imaging and histology using an in vitro 3-dimensional hydrogel collagen platform, ex vivo human specimens, and a mouse model of atherosclerosis. RESULTS Microcalcification size correlated inversely with collagen concentration. The 18F-fluoride ligand bound to microcalcifications formed by calcifying vascular smooth muscle cell derived extracellular vesicles in the in vitro 3-dimensional collagen system and exhibited an increasing signal with an increase in collagen concentration (0.25 mg/mL collagen -33.8×102±12.4×102 counts per minute; 0.5 mg/mL collagen -67.7×102±37.4×102 counts per minute; P=0.0014), suggesting amplification of the PET signal by smaller microcalcifications. We further incubated human atherosclerotic endarterectomy specimens with clinically relevant concentrations of 18F-fluoride. The 18F-fluoride ligand labeled microcalcifications in PET-positive, CT-negative regions of explanted human specimens as evidenced by 18F-fluoride PET/CT imaging, near-infrared fluorescence, and histological analysis. Additionally, the 18F-fluoride ligand identified micro and macrocalcifications in atherosclerotic aortas obtained from low-density lipoprotein receptor-deficient mice. CONCLUSIONS Our results suggest that 18F-fluoride PET signal in PET-positive, CT-negative regions of human atherosclerotic plaques is the result of developing microcalcifications, and high surface area in regions of small microcalcifications may amplify PET signal.
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Affiliation(s)
- Michael D Creager
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.D.C., T.H., F.S., M.C.B. L.H.L., S.A.S., M.A., E.A.)
| | - Tobias Hohl
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.D.C., T.H., F.S., M.C.B. L.H.L., S.A.S., M.A., E.A.)
| | | | - Alastair J Moss
- British Heart Foundation, Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.J.M., C.J.A.-C., A.A.S.T., D.E.N., M.R.D.)
| | - Florian Schlotter
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.D.C., T.H., F.S., M.C.B. L.H.L., S.A.S., M.A., E.A.)
| | - Mark C Blaser
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.D.C., T.H., F.S., M.C.B. L.H.L., S.A.S., M.A., E.A.)
| | - Mi-Ae Park
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.-A.P., M.F.K., M.D.C.)
| | - Lang Ho Lee
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.D.C., T.H., F.S., M.C.B. L.H.L., S.A.S., M.A., E.A.)
| | - Sasha A Singh
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.D.C., T.H., F.S., M.C.B. L.H.L., S.A.S., M.A., E.A.)
| | - Carlos J Alcaide-Corral
- British Heart Foundation, Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.J.M., C.J.A.-C., A.A.S.T., D.E.N., M.R.D.)
| | - Adriana A S Tavares
- British Heart Foundation, Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.J.M., C.J.A.-C., A.A.S.T., D.E.N., M.R.D.)
| | - David E Newby
- British Heart Foundation, Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.J.M., C.J.A.-C., A.A.S.T., D.E.N., M.R.D.)
| | - Marie F Kijewski
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.-A.P., M.F.K., M.D.C.)
| | - Masanori Aikawa
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.D.C., T.H., F.S., M.C.B. L.H.L., S.A.S., M.A., E.A.).,Division of Cardiovascular Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.A., E.A.)
| | - Marcelo Di Carli
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.-A.P., M.F.K., M.D.C.)
| | - Marc R Dweck
- British Heart Foundation, Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (A.J.M., C.J.A.-C., A.A.S.T., D.E.N., M.R.D.)
| | - Elena Aikawa
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.D.C., T.H., F.S., M.C.B. L.H.L., S.A.S., M.A., E.A.).,Division of Cardiovascular Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.A., E.A.)
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Hop H, de Boer SA, Reijrink M, Kamphuisen PW, de Borst MH, Pol RA, Zeebregts CJ, Hillebrands JL, Slart RHJA, Boersma HH, Doorduin J, Mulder DJ. 18F-sodium fluoride positron emission tomography assessed microcalcifications in culprit and non-culprit human carotid plaques. J Nucl Cardiol 2019; 26:1064-1075. [PMID: 29943142 PMCID: PMC6660502 DOI: 10.1007/s12350-018-1325-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/15/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND 18F-NaF positron emission tomography (PET) targets microcalcifications. We compared in vitro microPET assessed 18F-NaF uptake between culprit and non-culprit human carotid plaques. Furthermore, we compared 18F-NaF uptake with calcification visualized on microcomputed tomography (microCT). METHODS Carotid plaques from stroke patients undergoing surgery were incubated in 18F-NaF and scanned using a microPET and a microCT scan. The average PET assessed 18F-NaF uptake was expressed as percentage of the incubation dose per gram (%Inc/g). 18F-NaF PET volume of interest (VOI) was compared with CT calcification VOI. RESULTS 23 carotid plaques (17 culprit, 6 non-culprit) were included. The average 18F-NaF uptake in culprit carotid plaques was comparable with the uptake in non-culprit carotid plaques (median 2.32 %Inc/g [IQR 1.98 to 2.81] vs. median 2.35 %Inc/g [IQR 1.77 to 3.00], P = 0.916). Only a median of 10% (IQR 4 to 25) of CT calcification VOI showed increased 18F-NaF uptake, while merely a median of 35% (IQR 6 to 42) of 18F-NaF PET VOI showed calcification on CT. CONCLUSIONS 18F-NaF PET represents a different stage in the calcification process than CT. We observed a similar PET assessed 18F-NaF uptake and pattern in culprit and non-culprit plaques of high-risk patients, indicating that this method may be of more value in early atherosclerotic stenosis development.
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Affiliation(s)
- H Hop
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - S A de Boer
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - M Reijrink
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - P W Kamphuisen
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - M H de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R A Pol
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J L Hillebrands
- Division of Pathology, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - H H Boersma
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D J Mulder
- Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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27
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Moghbel M, Al-Zaghal A, Werner TJ, Constantinescu CM, Høilund-Carlsen PF, Alavi A. The Role of PET in Evaluating Atherosclerosis: A Critical Review. Semin Nucl Med 2018; 48:488-497. [DOI: 10.1053/j.semnuclmed.2018.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Cal-Gonzalez J, Li X, Heber D, Rausch I, Moore SC, Schäfers K, Hacker M, Beyer T. Partial volume correction for improved PET quantification in 18F-NaF imaging of atherosclerotic plaques. J Nucl Cardiol 2018; 25:1742-1756. [PMID: 28176255 PMCID: PMC6153866 DOI: 10.1007/s12350-017-0778-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/16/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Accurate quantification of plaque imaging using 18F-NaF PET requires partial volume correction (PVC). METHODS PVC of PET data was implemented by the use of a local projection (LP) method. LP-based PVC was evaluated with an image quality (NEMA) and with a thorax phantom with "plaque-type" lesions of 18-36 mL. The validated PVC method was then applied to a cohort of 17 patients, each with at least one plaque in the carotid or ascending aortic arteries. In total, 51 calcified (HU > 110) and 16 non-calcified plaque lesions (HU < 110) were analyzed. The lesion-to-background ratio (LBR) and the relative change of LBR (ΔLBR) were measured on PET. RESULTS Following PVC, LBR of the spheres (NEMA phantom) was within 10% of the original values. LBR of the thoracic lesions increased by 155% to 440% when the LP-PVC method was applied to the PET images. In patients, PVC increased the LBR in both calcified [mean = 78% (-8% to 227%)] and non-calcified plaques [mean = 41%, (-9%-104%)]. CONCLUSIONS PVC helps to improve LBR of plaque-type lesions in both phantom studies and clinical patients. Better results were obtained when the PVC method was applied to images reconstructed with point spread function modeling.
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Affiliation(s)
- Jacobo Cal-Gonzalez
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20/4L, 1090, Vienna, Austria.
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Heber
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ivo Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20/4L, 1090, Vienna, Austria
| | - Stephen C Moore
- Division of Nuclear Medicine, Department of Radiology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Klaus Schäfers
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Beyer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20/4L, 1090, Vienna, Austria
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29
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Liang M, Tan H, Zhou J, Wang T, Duan D, Fan K, He J, Cheng D, Shi H, Choi HS, Yan X. Bioengineered H-Ferritin Nanocages for Quantitative Imaging of Vulnerable Plaques in Atherosclerosis. ACS NANO 2018; 12:9300-9308. [PMID: 30165015 DOI: 10.1021/acsnano.8b04158] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Inflammation and calcification concomitantly drive atherosclerotic plaque progression and rupture and are the compelling targets for identifying plaque vulnerability. However, current imaging modalities for vulnerable atherosclerotic plaques are often limited by inadequate specificity and sensitivity. Here, we show that natural H-ferritin nanocages radiolabeled with technetium-99m (99mTc-HFn) can identify and accurately localize macrophage-rich, atherosclerotic plaques in living mice using combined SPECT and CT. Focal 99mTc-HFn uptake was observed in the atherosclerotic plaques with multiple high-risk features of macrophage infiltration, active calcification, positive remodeling, and necrosis on histology and in early active ongoing lesions with intense macrophage infiltration. The uptake of 99mTc-HFn in plaques enabled quantitative measuring of the dynamic changes of inflammation during plaque progression and anti-inflammation treatment. This strategy lays the foundation of using bioengineered endogenous human ferritin nanocages for the identification of vulnerable and early active plaques as well as potential assessment of anti-inflammation therapy.
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Affiliation(s)
- Minmin Liang
- Key Laboratory of Protein and Peptide Pharmaceutical, Institute of Biophysics , Chinese Academy of Sciences , Beijing 100101 , China
| | - Hui Tan
- Department of Nuclear Medicine, Zhongshan Hospital , Fudan University/Shanghai Institute of Medical Imaging , Shanghai 200032 , China
| | - Jun Zhou
- Department of Nuclear Medicine, Zhongshan Hospital , Fudan University/Shanghai Institute of Medical Imaging , Shanghai 200032 , China
| | - Tao Wang
- Peking University Third Hospital , Beijing 100191 , China
| | - Demin Duan
- Key Laboratory of Protein and Peptide Pharmaceutical, Institute of Biophysics , Chinese Academy of Sciences , Beijing 100101 , China
| | - Kelong Fan
- Key Laboratory of Protein and Peptide Pharmaceutical, Institute of Biophysics , Chinese Academy of Sciences , Beijing 100101 , China
| | - Jiuyang He
- Key Laboratory of Protein and Peptide Pharmaceutical, Institute of Biophysics , Chinese Academy of Sciences , Beijing 100101 , China
| | - Dengfeng Cheng
- Department of Nuclear Medicine, Zhongshan Hospital , Fudan University/Shanghai Institute of Medical Imaging , Shanghai 200032 , China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital , Fudan University/Shanghai Institute of Medical Imaging , Shanghai 200032 , China
| | - Hak Soo Choi
- Gordon Center for Medical Imaging, Department of Radiology , Massachusetts General Hospital and Harvard Medical School , Boston , Massachusetts 02114 , United States
| | - Xiyun Yan
- Key Laboratory of Protein and Peptide Pharmaceutical, Institute of Biophysics , Chinese Academy of Sciences , Beijing 100101 , China
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30
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18F-NaF and 18F-FDG as molecular probes in the evaluation of atherosclerosis. Eur J Nucl Med Mol Imaging 2018; 45:2190-2200. [PMID: 29978245 PMCID: PMC6182398 DOI: 10.1007/s00259-018-4078-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/21/2018] [Indexed: 12/12/2022]
Abstract
The early detection of atherosclerotic disease is vital to the effective prevention and management of life-threatening cardiovascular events such as myocardial infarctions and cerebrovascular accidents. Given the potential for positron emission tomography (PET) to visualize atherosclerosis earlier in the disease process than anatomic imaging modalities such as computed tomography (CT), this application of PET imaging has been the focus of intense scientific inquiry. Although 18F-FDG has historically been the most widely studied PET radiotracer in this domain, there is a growing body of evidence that 18F-NaF holds significant diagnostic and prognostic value as well. In this article, we review the existing literature on the application of 18F-FDG and 18F-NaF as PET probes in atherosclerosis and present the findings of original animal and human studies that have examined how well 18F-NaF uptake correlates with vascular calcification and cardiovascular risk.
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31
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Affiliation(s)
- Ying Wang
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China.,Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael T Osborne
- Department of Radiology, Massachusetts General Hospital, Boston, MA.,Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Brian Tung
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Ming Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yaming Li
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
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32
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Andrews JPM, Fayad ZA, Dweck MR. New methods to image unstable atherosclerotic plaques. Atherosclerosis 2018; 272:118-128. [PMID: 29602139 PMCID: PMC6463488 DOI: 10.1016/j.atherosclerosis.2018.03.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/06/2018] [Accepted: 03/09/2018] [Indexed: 12/11/2022]
Abstract
Atherosclerotic plaque rupture is the primary mechanism responsible for myocardial infarction and stroke, the top two killers worldwide. Despite being potentially fatal, the ubiquitous prevalence of atherosclerosis amongst the middle aged and elderly renders individual events relatively rare. This makes the accurate prediction of MI and stroke challenging. Advances in imaging techniques now allow detailed assessments of plaque morphology and disease activity. Both CT and MR can identify certain unstable plaque characteristics thought to be associated with an increased risk of rupture and events. PET imaging allows the activity of distinct pathological processes associated with atherosclerosis to be measured, differentiating patients with inactive and active disease states. Hybrid integration of PET with CT or MR now allows for an accurate assessment of not only plaque burden and morphology but plaque biology too. In this review, we discuss how these advanced imaging techniques hold promise in redefining our understanding of stable and unstable coronary artery disease beyond symptomatic status, and how they may refine patient risk-prediction and the rationing of expensive novel therapies.
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Affiliation(s)
- Jack P M Andrews
- Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, Royal Infirmary of Edinburgh, Edinburgh EH16 4SB, UK
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, Royal Infirmary of Edinburgh, Edinburgh EH16 4SB, UK
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33
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Choi H, Han JH, Lim SY, Lee I, Cho YS, Chun EJ, Lee WW. Imaging of Myocardial Ischemia-Reperfusion Injury Using Sodium [ 18F]Fluoride Positron Emission Tomography/Computed Tomography in Rats and Humans. Mol Imaging 2018; 16:1536012117704767. [PMID: 28654382 PMCID: PMC5470131 DOI: 10.1177/1536012117704767] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Positron emission tomography (PET)/computed tomography (CT) using sodium [18F]fluoride (Na[18F]F) has been proven to be a promising hot-spot imaging modality for myocardial infarction (MI). We investigated Na[18F]F uptake in ischemia–reperfusion injury (IRI) of rats and humans. Sodium [18F]fluoride PET/CT was performed in Sprague-Dawley rats that had IRI surgery, and it readily demonstrated prominent Na[18F]F uptake in the infarct area post-IRI. Sodium [18F]fluoride uptake was matched with negative 2,3,5-triphenyl-2H-tetrazolium chloride staining results, accompanied by myocardial apoptosis and associated with positive calcium staining results. Furthermore, area at risk was negative for Na[18F]F uptake. Cyclosporine A (CysA) treatment reduced standardized uptake value of 18F over the infarct area, and a significant decrease in infarct size was also observed by the CysA treatment. In humans, Na[18F]F PET/CT readily demonstrated increased Na[18F]F uptake in the 2 patients with MI post-percutaneous coronary intervention. In conclusion, this study sheds light on the potential utility of Na[18F]F PET/CT as a hot-spot imaging modality for myocardial IRI.
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Affiliation(s)
- Hongyoon Choi
- 1 Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hee Han
- 1 Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sue Yeon Lim
- 1 Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Inki Lee
- 1 Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Seok Cho
- 2 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- 3 Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won Woo Lee
- 1 Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.,4 Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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34
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35
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Weinberg RL, Morgenstern R, DeLuca A, Chen J, Bokhari S. F-18 sodium fluoride PET/CT does not effectively image myocardial inflammation due to suspected cardiac sarcoidosis. J Nucl Cardiol 2017; 24:2015-2018. [PMID: 27197820 DOI: 10.1007/s12350-016-0525-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sarcoidosis is an inflammatory disorder of unknown etiology that can involve the heart. While effective in imaging cardiac sarcoidosis, F-18 fluorodeoxyglucose (FDG) PET/CT often shows non-specific myocardial uptake. F-18 sodium fluoride (NaF) has been used to image inflammation in coronary artery plaques and has low background myocardial uptake. Here, we evaluated whether F-18 NaF can image myocardial inflammation due to clinically suspected cardiac sarcoidosis. PATIENTS AND METHODS We performed a single institution pilot study testing if F-18 NaF PET/CT can detect myocardial inflammation in patients with suspected cardiac sarcoidosis. Patients underwent cardiac PET/CT with F-18 FDG as part of their routine care and subsequently received an F-18 NaF PET/CT scan. RESULTS Three patients underwent F-18 FDG and F-18 NaF imaging. In all patients, there was F-18 FDG uptake consistent with cardiac sarcoidosis. The F-18 NaF PET/CT scans showed no myocardial uptake. CONCLUSIONS In this small preliminary study, PET/CT scan using F-18 NaF does not appear to detect myocardial inflammation caused by suspected cardiac sarcoidosis.
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Affiliation(s)
- Richard L Weinberg
- Nuclear Cardiology Laboratory, Columbia University College of Physicians and Surgeons, 622 W 168th Street, PH 10-203, New York, NY, 10032, USA.
- Division of Cardiovascular Medicine, University of Michigan Health System, Cardiovascular Center Room 2713, 1500 E Medical Center Dr SPC 5853, Ann Arbor, MI, 48109-5853, USA.
| | - Rachelle Morgenstern
- Nuclear Cardiology Laboratory, Columbia University College of Physicians and Surgeons, 622 W 168th Street, PH 10-203, New York, NY, 10032, USA
| | - Albert DeLuca
- Nuclear Cardiology Laboratory, Columbia University College of Physicians and Surgeons, 622 W 168th Street, PH 10-203, New York, NY, 10032, USA
| | - Jennifer Chen
- Nuclear Cardiology Laboratory, Columbia University College of Physicians and Surgeons, 622 W 168th Street, PH 10-203, New York, NY, 10032, USA
| | - Sabahat Bokhari
- Nuclear Cardiology Laboratory, Columbia University College of Physicians and Surgeons, 622 W 168th Street, PH 10-203, New York, NY, 10032, USA
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36
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Evans NR, Tarkin JM, Buscombe JR, Markus HS, Rudd JHF, Warburton EA. PET imaging of the neurovascular interface in cerebrovascular disease. Nat Rev Neurol 2017; 13:676-688. [PMID: 28984315 DOI: 10.1038/nrneurol.2017.129] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cerebrovascular disease encompasses a range of pathologies that affect different components of the cerebral vasculature and brain parenchyma. Large artery atherosclerosis, acute cerebral ischaemia, and intracerebral small vessel disease all demonstrate altered metabolic processes that are key to their pathogenesis. Although structural imaging techniques such as MRI are the mainstay of clinical care and research in cerebrovascular disease, they have limited ability to detect these pathophysiological processes in vivo. By contrast, PET can detect and quantify metabolic processes that are relevant to each facet of cerebrovascular disease. Information obtained from PET studies has helped to shape the understanding of key concepts in cerebrovascular medicine, including vulnerable atherosclerotic plaque, salvageable ischaemic penumbra, neuroinflammation and selective neuronal loss after ischaemic insult. PET has also helped to elucidate the relationships between chronic hypoxia, neuroinflammation, and amyloid-β deposition in cerebral small vessel disease. This Review describes how PET-based imaging of metabolic processes at the neurovascular interface has contributed to our understanding of cerebrovascular disease.
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Affiliation(s)
- Nicholas R Evans
- Department of Clinical Neurosciences, University of Cambridge, Box 83, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - John R Buscombe
- Department of Nuclear Medicine, Box 219, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Box 83, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Elizabeth A Warburton
- Department of Clinical Neurosciences, University of Cambridge, Box 83, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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Wanga S, Hibender S, Ridwan Y, van Roomen C, Vos M, van der Made I, van Vliet N, Franken R, van Riel LA, Groenink M, Zwinderman AH, Mulder BJ, de Vries CJ, Essers J, de Waard V. Aortic microcalcification is associated with elastin fragmentation in Marfan syndrome. J Pathol 2017; 243:294-306. [PMID: 28727149 DOI: 10.1002/path.4949] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 06/17/2017] [Accepted: 07/06/2017] [Indexed: 12/20/2022]
Abstract
Marfan syndrome (MFS) is a connective tissue disorder in which aortic rupture is the major cause of death. MFS patients with an aortic diameter below the advised limit for prophylactic surgery (<5 cm) may unexpectedly experience an aortic dissection or rupture, despite yearly monitoring. Hence, there is a clear need for improved prognostic markers to predict such aortic events. We hypothesize that elastin fragments play a causal role in aortic calcification in MFS, and that microcalcification serves as a marker for aortic disease severity. To address this hypothesis, we analysed MFS patient and mouse aortas. MFS patient aortic tissue showed enhanced microcalcification in areas with extensive elastic lamina fragmentation in the media. A causal relationship between medial injury and microcalcification was revealed by studies in vascular smooth muscle cells (SMCs); elastin peptides were shown to increase the activity of the calcification marker alkaline phosphatase (ALP) and reduce the expression of the calcification inhibitor matrix GLA protein in human SMCs. In murine Fbn1C1039G/+ MFS aortic SMCs, Alpl mRNA and activity were upregulated as compared with wild-type SMCs. The elastin peptide-induced ALP activity was prevented by incubation with lactose or a neuraminidase inhibitor, which inhibit the elastin receptor complex, and a mitogen-activated protein kinase kinase-1/2 inhibitor, indicating downstream involvement of extracellular signal-regulated kinase-1/2 (ERK1/2) phosphorylation. Histological analyses in MFS mice revealed macrocalcification in the aortic root, whereas the ascending aorta contained microcalcification, as identified with the near-infrared fluorescent bisphosphonate probe OsteoSense-800. Significantly, microcalcification correlated strongly with aortic diameter, distensibility, elastin breaks, and phosphorylated ERK1/2. In conclusion, microcalcification co-localizes with aortic elastin degradation in MFS aortas of humans and mice, where elastin-derived peptides induce a calcification process in SMCs via the elastin receptor complex and ERK1/2 activation. We propose microcalcification as a novel imaging marker to monitor local elastin degradation and thus predict aortic events in MFS patients. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Shaynah Wanga
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Stijntje Hibender
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Yanto Ridwan
- Department of Molecular Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Cindy van Roomen
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Mariska Vos
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Ingeborg van der Made
- Department of Experimental Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Nicole van Vliet
- Department of Molecular Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Romy Franken
- Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Luigi Amjg van Riel
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Maarten Groenink
- Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Barbara Jm Mulder
- Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Carlie Jm de Vries
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Essers
- Department of Molecular Genetics, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiation Oncology, Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Vivian de Waard
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
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Hetterich H, Webber N, Willner M, Herzen J, Birnbacher L, Auweter S, Schüller U, Bamberg F, Notohamiprodjo S, Bartsch H, Wolf J, Marschner M, Pfeiffer F, Reiser M, Saam T. Dark-field imaging in coronary atherosclerosis. Eur J Radiol 2017; 94:38-45. [PMID: 28941758 DOI: 10.1016/j.ejrad.2017.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/21/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Dark-field imaging based on small angle X-ray scattering has been shown to be highly sensitive for microcalcifications, e.g. in breast tissue. We hypothesized (i) that high signal areas in dark-field imaging of atherosclerotic plaque are associated with microcalcifications and (ii) that dark-field imaging is more sensitive for microcalcifications than attenuation-based imaging. METHODS Fifteen coronary artery specimens were examined at an experimental set-up consisting of X-ray tube (40kV), grating-interferometer and detector. Tomographic dark-field-, attenuation-, and phase-contrast data were simultaneously acquired. Histopathology served as standard of reference. To explore the potential of dark field imaging in a full-body CT system, simulations were carried out with spherical calcifications of different sizes to simulate small and intermediate microcalcifications. RESULTS Microcalcifications were present in 10/10 (100%) cross-sections with high dark-field signal and without evidence of calcifications in attenuation- or phase contrast. In positive controls with high signal areas in all three modalities, 10/10 (100%) cross-sections showed macrocalcifications. In negative controls without high signal areas, no calcifications were detected. Simulations showed that the microcalcifications generate substantially higher dark-field than attenuation signal. CONCLUSIONS Dark-field imaging is highly sensitive for microcalcifications in coronary atherosclerotic plaque and might provide complementary information in the assessment of plaque instability.
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Affiliation(s)
- Holger Hetterich
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
| | - Nicole Webber
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Marian Willner
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Julia Herzen
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Lorenz Birnbacher
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Ulrich Schüller
- Center for Neuropathology, Ludwig-Maximilians-University Hospital, Munich, Germany; Institute for Neuropathology, University Medical Center Hamburg, Germany; Department for Pediatric Hematology and Oncology, University Medical Center Hamburg, Germany
| | - Fabian Bamberg
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Susan Notohamiprodjo
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Harald Bartsch
- Institute of Pathology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Johannes Wolf
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Mathias Marschner
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Franz Pfeiffer
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Maximilian Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
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Dilsizian V, Jadvar H. Science to Practice: Does FDG Differentiate Morphologically Unstable from Stable Atherosclerotic Plaque? Radiology 2017; 283:1-3. [PMID: 28318446 DOI: 10.1148/radiol.2017162495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
It has been reported that fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) may detect the inflammatory state and macrophage burden of atherosclerotic plaques and potentially identify vulnerable plaques. However, published reports have been inconsistent in this area. Tavakoli et al ( 1 ) hypothesized that differential regulation of macrophage glucose metabolism by macrophage colony-stimulating factor (M-CSF; inflammation resolving) and granulocyte-M-CSF (GM-CSF; proinflammatory) may contribute to the inconsistency of FDG vessel wall inflammation. After the induction of inflammatory and metabolic profiles, both M-CSF and GM-CSF generated comparable levels of glucose uptake in cultured macrophages and murine atherosclerotic plaques. These findings suggest that although FDG uptake is an indicator of vascular macrophage burden (total number of macrophages), it may not necessarily differentiate morphologically unstable (inflammatory) from stable (noninflammatory) atherosclerotic plaque. Moreover, although atherosclerosis is characterized by macrophage-predominated inflammation, there is a wide range of other vascular diseases in which macrophages and inflammation play an important role in the absence of atherosclerosis. FDG uptake will be indistinguishable in atherosclerosis from large-artery inflammatory vascular disease, such as Takayasu arteritis, chemotherapy- or radiation-induced vascular inflammation, or foreign-body reaction, such as synthetic arterial graft. Because of the nonspecific nature of FDG uptake by any cell (upregulated under hypoxic conditions or other microenvironmental factors), this work calls for a more cautious approach to interpreting vascular FDG uptake as indicative of inflammatory atherosclerosis in the clinical setting.
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Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine University of Maryland School of Medicine Baltimore, Md
| | - Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology Keck School of Medicine, University of Southern California 2250 Alcazar St, CSC/IGM 102 Los Angeles, CA 90033
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40
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Atherosclerotic plaque metabolism in high cardiovascular risk subjects – A subclinical atherosclerosis imaging study with 18 F-NaF PET-CT. Atherosclerosis 2017; 260:41-46. [DOI: 10.1016/j.atherosclerosis.2017.03.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/17/2022]
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41
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Ishiwata Y, Kaneta T, Nawata S, Hino-Shishikura A, Yoshida K, Inoue T. Quantification of temporal changes in calcium score in active atherosclerotic plaque in major vessels by 18F-sodium fluoride PET/CT. Eur J Nucl Med Mol Imaging 2017; 44:1529-1537. [PMID: 28349280 DOI: 10.1007/s00259-017-3680-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/15/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Our aim was to assess whether 18F-NaF PET/CT is able to predict progression of the CT calcium score. METHODS Between August 2007 and November 2015, 34 patients (18 women, 16 men; age, mean ± standard deviation, 57.5 ± 13.9 years; age range 19-78 years) with malignancy or orthopaedic disease were enrolled in this study, with approximately 1-year follow-up data. Baseline and follow-up CT images were retrospectively evaluated for the presence of calcification sites in major vessel walls. The maximum and mean CT values (CTmax and CTmean, in Hounsfield units), calcification volumetric score (CVS, in cubic millimetres) and Agatston units score (AU) were evaluated for each site. Subsequent changes in CTmax, CTmean, CVS and AU were calculated and expressed as ΔCTmax, ΔCTmean, ΔCVS and ΔAU, respectively. We then evaluated the relationship between 18F-NaF uptake (using the maximum target-to-background ratio, TBRmax, and the maximum blood-subtracted 18F-NaF activity, bsNaFmax, which was obtained by subtracting the SUVmax of each calcified plaque lesion and NaF-avid site from the SUVmean in the right atrium blood pool) and the change in calcified plaque volume and characteristics obtained after 1 year. RESULTS We detected and analysed 182 calcified plaque sites and 96 hot spots on major vessel walls. 18F-NaF uptake showed very weak correlations with CTmax, CTmean, CVS, CVS after 1 year, AU and AU after 1 year on both baseline and follow-up PET/CT scans for each site. 18F-NaF uptake showed no correlation with ΔCTmax or ΔCTmean. However, there was a significant correlation between the intensity of 18F-NaF uptake and ΔCVS and ΔAU. CONCLUSION 18F-NaF uptake has a strong correlation with calcium score progression which was a predictor of future cardiovascular disease risk. PET/CT using 18F-NaF may be able to predict calcium score progression which is known to be the major characteristic of atherosclerosis.
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Affiliation(s)
- Yoshinobu Ishiwata
- Department of Radiology, Yokohama City University, Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ward, Yokohama, Kanagawa, 236-0004, Japan
| | - Tomohiro Kaneta
- Department of Radiology, Yokohama City University, Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ward, Yokohama, Kanagawa, 236-0004, Japan.
| | - Shintaro Nawata
- Department of Radiology, Yokohama City University, Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ward, Yokohama, Kanagawa, 236-0004, Japan
| | - Ayako Hino-Shishikura
- Department of Radiology, Yokohama City University, Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ward, Yokohama, Kanagawa, 236-0004, Japan
| | - Keisuke Yoshida
- Department of Radiology, Yokohama City University, Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ward, Yokohama, Kanagawa, 236-0004, Japan
| | - Tomio Inoue
- Department of Radiology, Yokohama City University, Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ward, Yokohama, Kanagawa, 236-0004, Japan
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43
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Evans NR, Tarkin JM, Chowdhury MM, Warburton EA, Rudd JHF. PET Imaging of Atherosclerotic Disease: Advancing Plaque Assessment from Anatomy to Pathophysiology. Curr Atheroscler Rep 2016; 18:30. [PMID: 27108163 PMCID: PMC4842219 DOI: 10.1007/s11883-016-0584-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atherosclerosis is a leading cause of morbidity and mortality. It is now widely recognized that the disease is more than simply a flow-limiting process and that the atheromatous plaque represents a nidus for inflammation with a consequent risk of plaque rupture and atherothrombosis, leading to myocardial infarction or stroke. However, widely used conventional clinical imaging techniques remain anatomically focused, assessing only the degree of arterial stenosis caused by plaques. Positron emission tomography (PET) has allowed the metabolic processes within the plaque to be detected and quantified directly. The increasing armory of radiotracers has facilitated the imaging of distinct metabolic aspects of atherogenesis and plaque destabilization, including macrophage-mediated inflammatory change, hypoxia, and microcalcification. This imaging modality has not only furthered our understanding of the disease process in vivo with new insights into mechanisms but has also been utilized as a non-invasive endpoint measure in the development of novel treatments for atherosclerotic disease. This review provides grounding in the principles of PET imaging of atherosclerosis, the radioligands in use and in development, its research and clinical applications, and future developments for the field.
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Affiliation(s)
- Nicholas R Evans
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Mohammed M Chowdhury
- Division of Vascular and Endovascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Elizabeth A Warburton
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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44
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Ruiz JL, Weinbaum S, Aikawa E, Hutcheson JD. Zooming in on the genesis of atherosclerotic plaque microcalcifications. J Physiol 2016; 594:2915-27. [PMID: 27040360 DOI: 10.1113/jp271339] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/23/2016] [Indexed: 01/08/2023] Open
Abstract
Epidemiological evidence conclusively demonstrates that calcium burden is a significant predictor of cardiovascular morbidity and mortality; however, the underlying mechanisms remain largely unknown. These observations have challenged the previously held notion that calcification serves to stabilize the atherosclerotic plaque. Recent studies have shown that microcalcifications that form within the fibrous cap of the plaques lead to the accrual of plaque-destabilizing mechanical stress. Given the association between calcification morphology and cardiovascular outcomes, it is important to understand the mechanisms leading to calcific mineral deposition and growth from the earliest stages. We highlight the open questions in the field of cardiovascular calcification and include a review of the proposed mechanisms involved in extracellular vesicle-mediated mineral deposition.
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Affiliation(s)
- Jessica L Ruiz
- Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sheldon Weinbaum
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Elena Aikawa
- Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua D Hutcheson
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Papadimitriou L, Smith-Jones PM, Sarwar CM, Marti CN, Yaddanapudi K, Skopicki HA, Gheorghiade M, Parsey R, Butler J. Utility of positron emission tomography for drug development for heart failure. Am Heart J 2016; 175:142-52. [PMID: 27179733 DOI: 10.1016/j.ahj.2016.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 02/22/2016] [Indexed: 12/14/2022]
Abstract
Only about 1 in 5,000 investigational agents in a preclinical stage acquires Food and Drug Administration approval. Among many reasons for this includes an inefficient transition from preclinical to clinical phases, which exponentially increase the cost and the delays the process of drug development. Positron emission tomography (PET) is a nuclear imaging technique that has been used for the diagnosis, risk stratification, and guidance of therapy. However, lately with the advance of radiochemistry and of molecular imaging technology, it became evident that PET could help novel drug development process. By using a PET radioligand to report on receptor occupancy during novel agent therapy, it may help assess the effectiveness, efficacy, and safety of such a new medication in an early preclinical stage and help design successful clinical trials even at a later phase. In this article, we explore the potential implications of PET in the development of new heart failure therapies and review PET's application in the respective pathophysiologic pathways such as myocardial perfusion, metabolism, innervation, inflammation, apoptosis, and cardiac remodeling.
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46
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Preclinical models of atherosclerosis. The future of Hybrid PET/MR technology for the early detection of vulnerable plaque. Expert Rev Mol Med 2016; 18:e6. [PMID: 27056676 DOI: 10.1017/erm.2016.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases are the leading cause of death in developed countries. The aetiology is currently multifactorial, thus making them very difficult to prevent. Preclinical models of atherothrombotic diseases, including vulnerable plaque-associated complications, are now providing significant insights into pathologies like atherosclerosis, and in combination with the most recent advances in new non-invasive imaging technologies, they have become essential tools to evaluate new therapeutic strategies, with which can forecast and prevent plaque rupture. Positron emission tomography (PET)/computed tomography imaging is currently used for plaque visualisation in clinical and pre-clinical cardiovascular research, albeit with significant limitations. However, the combination of PET and magnetic resonance imaging (MRI) technologies is still the best option available today, as combined PET/MRI scans provide simultaneous data acquisition together with high quality anatomical information, sensitivity and lower radiation exposure for the patient. The coming years may represent a new era for the implementation of PET/MRI in clinical practice, but first, clinically efficient attenuation correction algorithms and research towards multimodal reagents and safety issues should be validated at the preclinical level.
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Brinjikji W, Huston J, Rabinstein AA, Kim GM, Lerman A, Lanzino G. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg 2016. [DOI: 10.3171/2015.1.jns142452.test] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
PURPOSE Sodium [(18)F]fluoride (Na[(18)F]F) positron emission tomography with integrated computed tomography (PET/CT) has not been used for imaging myocardial infarction (MI). Here, we aimed to investigate the Na[(18)F]F PET/CT features of MI in a rat model. PROCEDURES MI was induced by coronary artery ligation in 8-week-old male Spraque-Dawley rats (300 ± 10 g) and confirmed by triphenyl tetrazolium chloride (TTC) staining. Na[(18)F]F PET/CT images were obtained using an animal-dedicated PET/CT scanner (NanoPET/CT, Mediso) in vivo and ex vivo. Uptake of Na[(18)F]F was quantitated using the standardized uptake value (SUV). Myocardial apoptosis was evaluated using histone-1 targeted peptide (ApoPep-1) and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining, while calcium accumulation was investigated using von Kossa's staining. Na[(18)F]F PET/CT was compared with (99m)Tc-methoxyisobutylisonitrile (MIBI) or (99m)Tc-hydroxymethylenediphosphonate (HMDP) single photon emission computed tomography/computed tomography (SPECT/CT) in rats with day 1 MI. RESULTS The rats showed strong Na[(18)F]F uptake both in vivo and ex vivo; the maximal uptake occurred 1 day after MI (SUV ratio of infarct to lung = 4.56 ± 0.74, n = 7, P = 0.0183 vs the control). The Na[(18)F]F uptake area perfectly matched the apoptotic area, determined by ApoPep-1 uptake and TUNEL assay. However, calcification, assessed by von Kossa's staining, was absent in the infarct. Na[(18)F]F PET/CT showed an increased uptake at the perfusion deficit area in [(99m)Tc]MIBI SPECT/CT and an equivalent signal to [(99m)Tc]HMDP SPECT/CT in rats with day 1 MI. CONCLUSIONS Na[(18)F]F PET/CT is a promising hot-spot imaging modality for MI.
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Affiliation(s)
- Jeong Hee Han
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea
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Brinjikji W, Huston J, Rabinstein AA, Kim GM, Lerman A, Lanzino G. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg 2015; 124:27-42. [PMID: 26230478 DOI: 10.3171/2015.1.jns142452] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify patients with low- and high-grade carotid artery stenosis. For example, identification of IPH on MRI in patients with low-grade carotid artery stenosis is a risk factor for failure of medical therapy, and studies have shown that such patients may fair better with carotid endarterectomy (CEA). MR plaque imaging has also been found to be useful in identifying revascularization candidates who would be better candidates for CEA than carotid artery stenting (CAS), as high intraplaque signal on time of flight imaging is associated with vulnerable plaque and increased rates of adverse events in patients undergoing CAS but not CEA.
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Affiliation(s)
| | | | | | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
The use of (18)F-sodium fluoride ((18)F-NaF) with PET/CT is increasing. This resurgence of an old tracer has been fueled by several factors including superior diagnostic performance over standard (99m)Tc-based bone scintigraphy, growth in the availability of PET/CT imaging systems, increase in the number of regional commercial distribution centers for PET radiotracers, the recent concerns about potential recurring shortages with (99m)Tc-based radiotracers, and the recent decision by the Centers for Medicare and Medicaid Services to reimburse for (18)F-NaF PET/CT for evaluation of patients with known or suspected bone metastases through the National Oncologic PET Registry. The major goal of this article is to review the current evidence on the diagnostic utility of (18)F-NaF in the imaging assessment of the bone and joint in a variety of clinical conditions.
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Affiliation(s)
- Hossein Jadvar
- PET/CT Imaging Science Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Bhushan Desai
- PET/CT Imaging Science Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Peter S Conti
- PET/CT Imaging Science Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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