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Reijrink M, Sluiter JKE, Te Velde-Keyzer CA, de Borst MH, van Praagh GD, Greuter MJW, Luurtsema G, Boersma HH, Pol RA, Hillebrands JL, van Dijk PR, Hoogenberg K, Mulder DJ, Slart RHJA. Severely increased albuminuria in patients with type 2 diabetes mellitus is associated with increased subclinical atherosclerosis in femoral arteries with Na [ 18F]F activity as a proxy - The DETERMINE study. Atherosclerosis 2024; 394:117199. [PMID: 37550141 DOI: 10.1016/j.atherosclerosis.2023.117199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND AND AIMS Sodium [18F]fluoride (Na [18F]F) positron emission tomography imaging allows detailed visualization of early arterial micro-calcifications. This study aims to investigate atherosclerosis manifested by micro-calcification, macro-calcification, and aortic stiffness in patients with type 2 diabetes mellitus (T2DM) with and without albuminuria and severely decreased kidney function. METHODS A cohort was stratified in four groups (N = 10 per group), based on KDIGO categories (G1-5 A1-3). G1-2A1 non-diabetic controls (median [IQR] estimated glomerular filtration rate (eGFR) in mL/min/1.73 m2 91 [81-104]), G1-2A1 with T2DM (eGFR 87 [84-93], and albumin-creatinin-ratio (ACR) in mg/mmol 0.35 [0.25-0.75]), G1-2A3 with T2DM (eGFR 85 [60-103], and ACR 74 [62-122], and G4A3 with T2DM (eGFR 19 [13-27] and ACR 131 [59-304]). RESULTS Na [18F]F femoral artery grading score differed significantly in the groups with the highest Na [18F]F activity in A3 groups with T2DM (G1-2A3 with T2DM 228 [100-446] and G4A3 with T2DM 198 [113-578]) from the lowest groups of the G1-2A1 with T2DM (33 [0-93]) and in G1-2A1 non-diabetic controls (75 [0-200], p = 0.001). Aortic Na [18F]F activity and femoral artery computed tomography (CT)-assessed macro-calcification was increased in G4A3 with T2DM compared with G1-2A1 with T2DM (47.5 [33.8-73.8] vs. 17.5 [8.8-27.5] (p = 0.006) and 291 [170-511] vs. 12.2 [1.41-44.3] mg (p = 0.032), respectively). Carotid-femoral pulse wave velocity (PWV)-assessed aortic stiffness was significantly higher in both A3 groups with T2DM compared with G1-2A1 with T2DM (11.15 and 12.35 vs. 8.86 m/s, respectively (p = 0.009)). CONCLUSIONS This study indicates that the presence of severely increased albuminuria in patients with T2DM is cross-sectionally associated with subclinical arterial disease in terms of micro-calcification and aortic stiffness. Additional decrease in kidney function was associated with advanced macro-calcifications.
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Affiliation(s)
- M Reijrink
- University of Groningen, University Medical Center Groningen, Dept. Internal Medicine, div. Vascular Medicine, the Netherlands.
| | - J K E Sluiter
- University of Groningen, University Medical Center Groningen, Dept. Internal Medicine, div. Vascular Medicine, the Netherlands
| | - C A Te Velde-Keyzer
- University of Groningen, University Medical Center Groningen, Dept. Internal Medicine, div. Nephrology, the Netherlands
| | - M H de Borst
- University of Groningen, University Medical Center Groningen, Dept. Internal Medicine, div. Nephrology, the Netherlands
| | - G D van Praagh
- University of Groningen, University Medical Center Groningen, Dept. Nuclear Medicine and Molecular Imaging, the Netherlands
| | - M J W Greuter
- University of Groningen, University Medical Center Groningen, Medical Imaging Center, Department of Radiology, Groningen, the Netherlands
| | - G Luurtsema
- University of Groningen, University Medical Center Groningen, Dept. Nuclear Medicine and Molecular Imaging, the Netherlands
| | - H H Boersma
- University of Groningen, University Medical Center Groningen, Dept. Nuclear Medicine and Molecular Imaging, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, the Netherlands
| | - R A Pol
- University of Groningen, University Medical Center Groningen, Department of Vascular and Transplant Surgery, Groningen, the Netherlands
| | - J L Hillebrands
- University of Groningen, University Medical Center Groningen, Dept. Pathology and Medical Biology, div. Pathology, the Netherlands
| | - P R van Dijk
- University of Groningen, University Medical Center Groningen, Dept. Internal Medicine, div. Endocrinology, the Netherlands
| | - K Hoogenberg
- Department of Internal Medicine, Martini Hospital, Groningen, the Netherlands
| | - D J Mulder
- University of Groningen, University Medical Center Groningen, Dept. Internal Medicine, div. Vascular Medicine, the Netherlands
| | - R H J A Slart
- University of Groningen, University Medical Center Groningen, Dept. Nuclear Medicine and Molecular Imaging, the Netherlands; University of Twente, Dept. of Biomedical Phototonic Imaging, Enschede, the Netherlands
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2
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Piri R, Edenbrandt L, Larsson M, Enqvist O, Skovrup S, Iversen KK, Saboury B, Alavi A, Gerke O, Høilund-Carlsen PF. "Global" cardiac atherosclerotic burden assessed by artificial intelligence-based versus manual segmentation in 18F-sodium fluoride PET/CT scans: Head-to-head comparison. J Nucl Cardiol 2022; 29:2531-2539. [PMID: 34386861 DOI: 10.1007/s12350-021-02758-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Artificial intelligence (AI) is known to provide effective means to accelerate and facilitate clinical and research processes. So in this study it was aimed to compare a AI-based method for cardiac segmentation in positron emission tomography/computed tomography (PET/CT) scans with manual segmentation to assess global cardiac atherosclerosis burden. METHODS A trained convolutional neural network (CNN) was used for cardiac segmentation in 18F-sodium fluoride PET/CT scans of 29 healthy volunteers and 20 angina pectoris patients and compared with manual segmentation. Parameters for segmented volume (Vol) and mean, maximal, and total standardized uptake values (SUVmean, SUVmax, SUVtotal) were analyzed by Bland-Altman Limits of Agreement. Repeatability with AI-based assessment of the same scans is 100%. Repeatability (same conditions, same operator) and reproducibility (same conditions, two different operators) of manual segmentation was examined by re-segmentation in 25 randomly selected scans. RESULTS Mean (± SD) values with manual vs. CNN-based segmentation were Vol 617.65 ± 154.99 mL vs 625.26 ± 153.55 mL (P = .21), SUVmean 0.69 ± 0.15 vs 0.69 ± 0.15 (P = .26), SUVmax 2.68 ± 0.86 vs 2.77 ± 1.05 (P = .34), and SUVtotal 425.51 ± 138.93 vs 427.91 ± 132.68 (P = .62). Limits of agreement were - 89.42 to 74.2, - 0.02 to 0.02, - 1.52 to 1.32, and - 68.02 to 63.21, respectively. Manual segmentation lasted typically 30 minutes vs about one minute with the CNN-based approach. The maximal deviation at manual re-segmentation was for the four parameters 0% to 0.5% with the same and 0% to 1% with different operators. CONCLUSION The CNN-based method was faster and provided values for Vol, SUVmean, SUVmax, and SUVtotal comparable to the manually obtained ones. This AI-based segmentation approach appears to offer a more reproducible and much faster substitute for slow and cumbersome manual segmentation of the heart.
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Affiliation(s)
- Reza Piri
- Department of Nuclear Medicine, Odense University Hospital, 5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | | | - Olof Enqvist
- Eigenvision AB, Malmö, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Sofie Skovrup
- Department of Nuclear Medicine, Odense University Hospital, 5000, Odense C, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Babak Saboury
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD, USA
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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3
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Piri R, Edenbrandt L, Larsson M, Enqvist O, Nøddeskou-Fink AH, Gerke O, Høilund-Carlsen PF. Aortic wall segmentation in 18F-sodium fluoride PET/CT scans: Head-to-head comparison of artificial intelligence-based versus manual segmentation. J Nucl Cardiol 2022; 29:2001-2010. [PMID: 33982202 DOI: 10.1007/s12350-021-02649-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed to establish and test an automated AI-based method for rapid segmentation of the aortic wall in positron emission tomography/computed tomography (PET/CT) scans. METHODS For segmentation of the wall in three sections: the arch, thoracic, and abdominal aorta, we developed a tool based on a convolutional neural network (CNN), available on the Research Consortium for Medical Image Analysis (RECOMIA) platform, capable of segmenting 100 different labels in CT images. It was tested on 18F-sodium fluoride PET/CT scans of 49 subjects (29 healthy controls and 20 angina pectoris patients) and compared to data obtained by manual segmentation. The following derived parameters were compared using Bland-Altman Limits of Agreement: segmented volume, and maximal, mean, and total standardized uptake values (SUVmax, SUVmean, SUVtotal). The repeatability of the manual method was examined in 25 randomly selected scans. RESULTS CNN-derived values for volume, SUVmax, and SUVtotal were all slightly, i.e., 13-17%, lower than the corresponding manually obtained ones, whereas SUVmean values for the three aortic sections were virtually identical for the two methods. Manual segmentation lasted typically 1-2 hours per scan compared to about one minute with the CNN-based approach. The maximal deviation at repeat manual segmentation was 6%. CONCLUSIONS The automated CNN-based approach was much faster and provided parameters that were about 15% lower than the manually obtained values, except for SUVmean values, which were comparable. AI-based segmentation of the aorta already now appears as a trustworthy and fast alternative to slow and cumbersome manual segmentation.
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Affiliation(s)
- Reza Piri
- Department of Nuclear Medicine, Odense University Hospital, 5000, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | | | - Olof Enqvist
- Eigenvision AB, Malmö, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Yang W, Zhong Z, Feng G, Wang Z. Advances in positron emission tomography tracers related to vascular calcification. Ann Nucl Med 2022; 36:787-797. [PMID: 35834116 DOI: 10.1007/s12149-022-01771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022]
Abstract
Microcalcification, a type of vascular calcification, increases the instability of plaque and easily leads to acute clinical events. Positron emission tomography (PET) is a new examination technology with significant advantages in identifying vascular calcification, especially microcalcification. The use of the 18F-NaF is undoubtedly the benchmark, and other PET tracers related to vascular calcification are also currently in development. Despite all this, a large number of studies are still needed to further clarify the specific mechanisms and characteristics. This review aimed at providing a summary of the application and progress of different PET tracers and also the future development direction.
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Affiliation(s)
- Wenjun Yang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Zhiqi Zhong
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Guoquan Feng
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China.
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5
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Ashwathanarayana AG, Singhal M, Satapathy S, Sood A, Mittal BR, Kumar RM, Parmar M, Krishnappa D, Rana N. 18F-NaF PET uptake characteristics of coronary artery culprit lesions in a cohort of patients of acute coronary syndrome with ST-elevation myocardial infarction and chronic stable angina: A hybrid fluoride PET/CTCA study. J Nucl Cardiol 2022; 29:558-568. [PMID: 32720061 DOI: 10.1007/s12350-020-02284-0] [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: 03/17/2020] [Accepted: 07/08/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND 18F-NaF PET/CT identifies high-risk plaques due to active calcification in coronary arteries with potential to characterize plaques in ST-elevation myocardial infarction (MI) and chronic stable angina (CSA) patients. METHODS Twenty-four MI and 17 CSA patients were evaluated with 18F-NaF PET/CTCA for SUVmax and TBR values of culprit and non-culprit plaques in both groups (inter-group and intra-group comparison), and pre- and post-interventional MI plaques sub-analysis. RESULTS Culprit plaques in MI patients had significantly higher SUVmax (1.6; IQR 0.6 vs 1.3; IQR 0.3, P = 0.03) and TBR (1.4; IQR 0.6 vs 1.1; IQR 0.4, P = 0.006) than culprit plaques of CSA. Pre-interventional culprit plaques of MI group (n = 11) revealed higher SUVmax (P = 0.007) and TBR (P = 0.008) values than culprit CSA plaques. Culprit plaques showed significantly higher SUVmax (P = 0.006) and TBR (P = 0.0003) than non-culprit plaques in MI group, but without significant difference between culprit and non-culprit plaques in CSA group. With median TBR cutoff value of 1.4 in MI culprit plaques, 6/7 plaques (85.7%) among the event prone non-culprit lesions had TBR values > 1.4 in CSA group. CONCLUSION The study shows higher SUVmax and TBR values in MI culprit plaques and comparable TBR values for event prone plaques of CSA group in identifying high-risk plaques.
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Affiliation(s)
- Abhiram G Ashwathanarayana
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radio-Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohit Manoj Kumar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madan Parmar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Darshan Krishnappa
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nivedita Rana
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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6
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Piri R, Nøddeskou-Fink AH, Gerke O, Larsson M, Edenbrandt L, Enqvist O, Høilund-Carlsen PF, Stochkendahl MJ. PET/CT imaging of spinal inflammation and microcalcification in patients with low back pain: A pilot study on the quantification by artificial intelligence-based segmentation. Clin Physiol Funct Imaging 2022; 42:225-232. [PMID: 35319166 PMCID: PMC9322590 DOI: 10.1111/cpf.12751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/11/2022] [Indexed: 12/29/2022]
Abstract
Background Current imaging modalities are often incapable of identifying nociceptive sources of low back pain (LBP). We aimed to characterize these by means of positron emission tomography/computed tomography (PET/CT) of the lumbar spine region applying tracers 18F‐fluorodeoxyglucose (FDG) and 18F‐sodium fluoride (NaF) targeting inflammation and active microcalcification, respectively. Methods Using artificial intelligence (AI)‐based quantification, we compared PET findings in two sex‐ and age‐matched groups, a case group of seven males and five females, mean age 45 ± 14 years, with ongoing LBP and a similar control group of 12 pain‐free individuals. PET/CT scans were segmented into three distinct volumes of interest (VOIs): lumbar vertebral bodies, facet joints and intervertebral discs. Maximum, mean and total standardized uptake values (SUVmax, SUVmean and SUVtotal) for FDG and NaF uptake in the 3 VOIs were measured and compared between groups. Holm–Bonferroni correction was applied to adjust for multiple testing. Results FDG uptake was slightly higher in most locations of the LBP group including higher SUVmean in the intervertebral discs (0.96 ± 0.34 vs. 0.69 ± 0.15). All NaF uptake values were higher in cases, including higher SUVmax in the intervertebral discs (11.63 ± 3.29 vs. 9.45 ± 1.32) and facet joints (14.98 ± 6.55 vs. 10.60 ± 2.97). Conclusion Observed intergroup differences suggest acute inflammation and microcalcification as possible nociceptive causes of LBP. AI‐based quantification of relevant lumbar VOIs in PET/CT scans of LBP patients and controls appears to be feasible. These promising, early findings warrant further investigation and confirmation.
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Affiliation(s)
- Reza Piri
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olof Enqvist
- Eigenvision AB, Malmö, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Poul-Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette J Stochkendahl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
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7
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Alavi A, Saboury B, Nardo L, Zhang V, Wang M, Li H, Raynor WY, Werner TJ, Høilund-Carlsen PF, Revheim ME. Potential and Most Relevant Applications of Total Body PET/CT Imaging. Clin Nucl Med 2022; 47:43-55. [PMID: 34874348 DOI: 10.1097/rlu.0000000000003962] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ABSTRACT The introduction of total body (TB) PET/CT instruments over the past 2 years has initiated a new and exciting era in medical imaging. These instruments have substantially higher sensitivity (up to 68 times) than conventional modalities and therefore allow imaging the entire body over a short period. However, we need to further refine the imaging protocols of this instrument for different indications. Total body PET will allow accurate assessment of the extent of disease, particularly, including the entire axial and appendicular skeleton. Furthermore, delayed imaging with this instrument may enhance the sensitivity of PET for some types of cancer. Also, this modality may improve the detection of venous thrombosis, a common complication of cancer and chemotherapy, in the extremities and help prevent pulmonary embolism. Total body PET allows assessment of atherosclerotic plaques throughout the body as a systematic disease. Similarly, patients with widespread musculoskeletal disorders including both oncologic and nononcologic entities, such as degenerative joint disease, rheumatoid arthritis, and osteoporosis, may benefit from the use of TB-PET. Finally, quantitative global disease assessment provided by this approach will be superior to conventional measurements, which do not reflect overall disease activity. In conclusion, TB-PET imaging may have a revolutionary impact on day-to-day practice of medicine and may become the leading imaging modality in the future.
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Affiliation(s)
- Abass Alavi
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Lorenzo Nardo
- Department of Radiology, University of California, Davis, Sacramento, CA
| | - Vincent Zhang
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital, Henan, China
| | - Hongdi Li
- United Imaging Healthcare, Houston, TX
| | - William Y Raynor
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Thomas J Werner
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
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8
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Takx RAP, van Asperen R, Bartstra JW, Zwakenberg SR, Wolterink JM, Celeng C, de Jong PA, Beulens JW. Determinants of 18F-NaF uptake in femoral arteries in patients with type 2 diabetes mellitus. J Nucl Cardiol 2021; 28:2700-2705. [PMID: 32185685 PMCID: PMC8709815 DOI: 10.1007/s12350-020-02099-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The goal of this study was to investigate the potential determinants of 18F-NaF uptake in femoral arteries as a marker of arterial calcification in patients with type 2 diabetes and a history of arterial disease. METHODS AND RESULTS The study consisted of participants of a randomized controlled trial to investigate the effect of vitamin K2 (NCT02839044). In this prespecified analysis, subjects with type 2 diabetes and known arterial disease underwent full body 18F-NaF PET/CT. Target-to-background ratio (TBR) was calculated by dividing the mean SUVmax from both superficial femoral arteries by the SUVmean in the superior vena cava (SVC) and calcium mass was measured on CT. The association between 18F-NaF TBR and cardiovascular risk factors was investigated using uni- and multivariate linear regression corrected for age and sex. In total, 68 patients (mean age: 69 ± 8 years; male: 52) underwent 18F-NaF PET/CT. Higher CT calcium mass, total cholesterol, and HbA1c were associated with higher 18F-NaF TBR after adjusting. CONCLUSION This study shows that several modifiable cardiovascular risk factors (total cholesterol, triglycerides, HbA1c) are associated with femoral 18F-NaF tracer uptake in patients with type 2 diabetes.
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Affiliation(s)
- Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Ruth van Asperen
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jonas W Bartstra
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Sabine R Zwakenberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelmer M Wolterink
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Csilla Celeng
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Joline W Beulens
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Vrije Universiteit, University Medical Center, Amsterdam, The Netherlands
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9
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Arani LS, Zirakchian Zadeh M, Saboury B, Revheim ME, Øestergaard B, Borja AJ, Samadi Samarin D, Mehdizadeh Seraj S, Kalbush E, Ayubcha C, Morris MA, Werner TJ, Abildgaard N, Høilund-Carlsen PF, Alavi A. Assessment of atherosclerosis in multiple myeloma and smoldering myeloma patients using 18F- sodium fluoride PET/CT. J Nucl Cardiol 2021; 28:3044-3054. [PMID: 33389640 DOI: 10.1007/s12350-020-02446-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To compare the NaF uptake in the thoracic aorta and whole heart, as an early indicator of atherosclerosis, in multiple myeloma (MM) and smoldering multiple myeloma (SMM) patients with a healthy control (HC) group. METHODS Forty-four untreated myeloma patients (35 MM and nine SMM) and twenty-six age and gender-matched HC subjects were collected. Each individual's NaF uptake in three parts of the aorta (AA: ascending aorta, AR: aortic arch, DA: descending aorta) and the whole heart was segmented. Average global standardized uptake value means were derived by sum of the product of each slice area divided by the sum of those slice areas. Results were reported as target to background ratio (TBR). RESULTS There was a significant difference between the NaF uptake in the thoracic aorta of myeloma and HC groups [AA (myeloma = 1.82 ± 0.21, HC = 1.24 ± 0.02), AR (myeloma = 1.71 ± 0.19, HC = 1.28 ± 0.03) and DA (myeloma = 1.96 ± 0.28, HC = 1.38 ± 0.03); P-values < 0.001]. The difference in the whole heart NaF uptake between two groups was also significant (P < 0.001). CONCLUSIONS We observed a higher uptake of NaF in the thoracic aorta and whole heart of myeloma patients in comparison to the matched control group.
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Affiliation(s)
- Leila S Arani
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Mahdi Zirakchian Zadeh
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
- Dental School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Babak Saboury
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Brian Øestergaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Austin J Borja
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Davoud Samadi Samarin
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Siavash Mehdizadeh Seraj
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Eman Kalbush
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Cyrus Ayubcha
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Michael A Morris
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Tom J Werner
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Hematology Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.
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10
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Benz DC, Buechel RR, Dorbala S. (18)F-sodium fluoride PET in multiple myeloma: Linking cancer to atherosclerosis? J Nucl Cardiol 2021; 28:3055-3057. [PMID: 33398792 DOI: 10.1007/s12350-020-02447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
- Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland.
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Sharmila Dorbala
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Cardiovascular Division, Department of Radiology, CV Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
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11
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Saboury B, Edenbrandt L, Piri R, Gerke O, Werner T, Arbab-Zadeh A, Alavi A, Høilund-Carlsen PF. Alavi-Carlsen Calcification Score (ACCS): A Simple Measure of Global Cardiac Atherosclerosis Burden. Diagnostics (Basel) 2021; 11:1421. [PMID: 34441355 PMCID: PMC8391812 DOI: 10.3390/diagnostics11081421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
Multislice cardiac CT characterizes late stage macrocalcification in epicardial arteries as opposed to PET/CT, which mirrors early phase arterial wall changes in epicardial and transmural coronary arteries. With regard to tracer, there has been a shift from using mainly 18F-fluorodeoxyglucose (FDG), indicating inflammation, to applying predominantly 18F-sodium fluoride (NaF) due to its high affinity for arterial wall microcalcification and more consistent association with cardiovascular risk factors. To make NaF-PET/CT an indispensable adjunct to clinical assessment of cardiac atherosclerosis, the Alavi-Carlsen Calcification Score (ACCS) has been proposed. It constitutes a global assessment of cardiac atherosclerosis burden in the individual patient, supported by an artificial intelligence (AI)-based approach for fast observer-independent segmentation. Common measures for characterizing epicardial coronary atherosclerosis by NaF-PET/CT as the maximum standardized uptake value (SUV) or target-to-background ratio are more versatile, error prone, and less reproducible than the ACCS, which equals the average cardiac SUV. The AI-based approach ensures a quick and easy delineation of the entire heart in 3D to obtain the ACCS expressing ongoing global cardiac atherosclerosis, even before it gives rise to CT-detectable coronary calcification. The quantification of global cardiac atherosclerotic burden by the ACCS is suited for management triage and monitoring of disease progression with and without intervention.
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Affiliation(s)
- Babak Saboury
- Clinical Center, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA;
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250, USA
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden;
- Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, 41345 Gothenburg, Sweden
| | - Reza Piri
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense C, Denmark; (R.P.); (O.G.)
- Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense C, Denmark; (R.P.); (O.G.)
- Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - Tom Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Armin Arbab-Zadeh
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense C, Denmark; (R.P.); (O.G.)
- Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
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12
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18F-Sodium Fluoride PET as a Diagnostic Modality for Metabolic, Autoimmune, and Osteogenic Bone Disorders: Cellular Mechanisms and Clinical Applications. Int J Mol Sci 2021; 22:ijms22126504. [PMID: 34204387 PMCID: PMC8234710 DOI: 10.3390/ijms22126504] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 01/31/2023] Open
Abstract
In a healthy body, homeostatic actions of osteoclasts and osteoblasts maintain the integrity of the skeletal system. When cellular activities of osteoclasts and osteoblasts become abnormal, pathological bone conditions, such as osteoporosis, can occur. Traditional imaging modalities, such as radiographs, are insensitive to the early cellular changes that precede gross pathological findings, often leading to delayed disease diagnoses and suboptimal therapeutic strategies. 18F-sodium fluoride (18F-NaF)-positron emission tomography (PET) is an emerging imaging modality with the potential for early diagnosis and monitoring of bone diseases through the detection of subtle metabolic changes. Specifically, the dissociated 18F- is incorporated into hydroxyapatite, and its uptake reflects osteoblastic activity and bone perfusion, allowing for the quantification of bone turnover. While 18F-NaF-PET has traditionally been used to detect metastatic bone disease, recent literature corroborates the use of 18F-NaF-PET in benign osseous conditions as well. In this review, we discuss the cellular mechanisms of 18F-NaF-PET and examine recent findings on its clinical application in diverse metabolic, autoimmune, and osteogenic bone disorders.
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13
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Piri R, Lici G, Riyahimanesh P, Gerke O, Alavi A, Høilund-Carlsen PF. Two-year change in 18F-sodium fluoride uptake in major arteries of healthy subjects and angina pectoris patients. Int J Cardiovasc Imaging 2021; 37:3115-3126. [PMID: 33950330 DOI: 10.1007/s10554-021-02263-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Abstract
To examine 2-year changes in carotid and aortic 18F-sodium fluoride (NaF) uptake in both healthy controls and angina pectoris patients. Twenty-nine healthy subjects and 20 angina pectoris patients underwent 90-min NaF-PET/CT twice 2 years apart. The carotids and three sections of the aorta (arch, thoracic, abdominal) were manually segmented. NaF uptake was expressed as the mean and total standardized uptake values without and with partial volume correction (SUVmean, SUVtotal and pvcSUVmean, pvcSUVtotal). Insignificant tendencies were higher NaF uptake in angina patients at both time points with less uptake in healthy subjects and higher uptake in angina patients after 2 years. Thus, aortic pvcSUVmean of angina patients was 1.14 ± 0.35 and 1.29 ± 0.71 at baseline and after 2 years vs. 0.99 ± 0.31 and 0.95 ± 0.28 in healthy subjects. A similar pattern was observed for the carotid pvcSUVmean. NaF uptake at baseline could not predict a change in CT-calcification after 2 years. NaF uptake in all parts of the aorta correlated positively with age. There was an insignificant, but consistent, tendency for slightly higher arterial NaF uptake in the angina group indicating more ongoing microcalcification at both time points in patients than healthy subjects. The 2-year changes were in both groups very small suggesting that the atherosclerotic process is slow, albeit with a tendency of slight decreases among healthy controls and slight increases in angina patients despite statin therapy in half of these.
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Affiliation(s)
- Reza Piri
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Gauher Lici
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pooriya Riyahimanesh
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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14
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Borja AJ, Hancin EC, Zhang V, Koa B, Bhattaru A, Rojulpote C, Detchou DK, Aly M, Kaghazchi F, Gerke O, Patil S, Gonuguntla K, Werner TJ, Revheim ME, Høilund-Carlsen PF, Alavi A. Global brain glucose uptake on 18F-FDG-PET/CT is influenced by chronic cardiovascular risk. Nucl Med Commun 2021; 42:444-450. [PMID: 33323870 DOI: 10.1097/mnm.0000000000001349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The goal of this study was to assess global cerebral glucose uptake in subjects with known cardiovascular risk factors by employing a quantitative 18F-fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT) technique. We hypothesized that at-risk subjects would demonstrate decreased global brain glucose uptake compared to healthy controls. METHODS We compared 35 healthy male controls and 14 male subjects at increased risk for cardiovascular disease (CVD) as assessed by the systematic coronary risk evaluation (SCORE) tool. All subjects were grouped into two age-matched cohorts: younger (<50 years) and older (≥50 years). The global standardized uptake value mean (Avg SUVmean) was measured by mapping regions of interest of the entire brain across the supratentorial structures and cerebellum. Wilcoxon's rank-sum test was used to assess the differences in Avg SUVmean between controls and at-risk subjects. RESULTS Younger subjects demonstrated higher brain Avg SUVmean than older subjects. In addition, in both age strata, the 10-year risk for fatal CVD according to the SCORE tool was significantly greater in the at-risk groups than in healthy controls (younger: P = 0.0304; older: P = 0.0436). In the younger cohort, at-risk subjects demonstrated significantly lower brain Avg SUVmean than healthy controls (P = 0.0355). In the older cohort, at-risk subjects similarly had lower Avg SUVmean than controls (P = 0.0343). CONCLUSIONS Global brain glucose uptake appears to be influenced by chronic cardiovascular risk factors. Therefore, FDG-PET/CT may play a role in determining the importance of CVD on brain function and has potential for monitoring the efficacy of various therapeutic interventions.
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Affiliation(s)
- Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania
- Perelman School of Medicine, University of Pennsylvania
| | - Emily C Hancin
- Department of Radiology, Hospital of the University of Pennsylvania
- Lewis Katz School of Medicine, Temple University
| | - Vincent Zhang
- Department of Radiology, Hospital of the University of Pennsylvania
| | - Benjamin Koa
- Department of Radiology, Hospital of the University of Pennsylvania
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Abhijit Bhattaru
- Department of Radiology, Hospital of the University of Pennsylvania
| | | | - Donald K Detchou
- Department of Radiology, Hospital of the University of Pennsylvania
- Perelman School of Medicine, University of Pennsylvania
| | - Mahmoud Aly
- Department of Radiology, Hospital of the University of Pennsylvania
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital
- Department of Clinical Research, Research Unit of Clinical Physiology and Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Shivaraj Patil
- Department of Radiology, Hospital of the University of Pennsylvania
- Department of Medicine, University of Connecticut, Hartford, Connecticut, USA
| | - Karthik Gonuguntla
- Department of Radiology, Hospital of the University of Pennsylvania
- Department of Medicine, University of Connecticut, Hartford, Connecticut, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital
- Department of Clinical Research, Research Unit of Clinical Physiology and Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania
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15
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Mayer M, Borja AJ, Hancin EC, Auslander T, Revheim ME, Moghbel MC, Werner TJ, Alavi A, Rajapakse CS. Imaging Atherosclerosis by PET, With Emphasis on the Role of FDG and NaF as Potential Biomarkers for This Disorder. Front Physiol 2020; 11:511391. [PMID: 33192540 PMCID: PMC7642524 DOI: 10.3389/fphys.2020.511391] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
Molecular imaging has emerged in the past few decades as a novel means to investigate atherosclerosis. From a pathophysiological perspective, atherosclerosis is characterized by microscopic inflammation and microcalcification that precede the characteristic plaque buildup in arterial walls detected by traditional assessment methods, including anatomic imaging modalities. These processes of inflammation and microcalcification are, therefore, prime targets for molecular detection of atherosclerotic disease burden. Imaging with positron emission tomography/computed tomography (PET/CT) using 18F-fluorodeoxyglucose (FDG) and 18F-sodium fluoride (NaF) can non-invasively assess arterial inflammation and microcalcification, respectively. FDG uptake reflects glucose metabolism, which is particularly increased in atherosclerotic plaques retaining macrophages and undergoing hypoxic stress. By contrast, NaF uptake reflects the exchange of hydroxyl groups of hydroxyapatite crystals for fluoride producing fluorapatite, a key biochemical step in calcification of atherosclerotic plaque. Here we review the existing literature on FDG and NaF imaging and their respective values in investigating the progression of atherosclerotic disease. Based on the large volume of data that have been introduced to the literature and discussed in this review, it is clear that PET imaging will have a major role to play in assessing atherosclerosis in the major and coronary arteries. However, it is difficult to draw definitive conclusions on the potential role of FDG in investigating atherosclerosis given the vast number of studies with different designs, image acquisition methods, analyses, and interpretations. Our experience in this domain of research has suggested that NaF may be the tool of choice over FDG in assessing atherosclerosis, especially in the setting of coronary artery disease (CAD). Specifically, global NaF assessment appears to be superior in detecting plaques in tissues with high background FDG activity, such as the coronary arteries.
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Affiliation(s)
- Michael Mayer
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Emily C Hancin
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.,Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Thomas Auslander
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mateen C Moghbel
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Chamith S Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.,Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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16
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Saboury B, Morris MA, Nikpanah M, Werner TJ, Jones EC, Alavi A. Reinventing Molecular Imaging with Total-Body PET, Part II: Clinical Applications. PET Clin 2020; 15:463-475. [PMID: 32888545 PMCID: PMC7462547 DOI: 10.1016/j.cpet.2020.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Total-body PET scans will initiate a new era for the PET clinic. The benefits of 40-fold effective sensitivity improvement provide new capabilities to image with lower radiation dose, perform delayed imaging, and achieve improved temporal resolution. These technical features are detailed in the first of this 2-part series. In this part, the clinical impacts of the novel features of total-body PET scans are further explored. Applications of total-body PET scans focus on the real-time interrogation of systemic disease manifestations in a variety of practical clinical contexts. Total-body PET scans make clinical systems biology imaging a reality.
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Affiliation(s)
- Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Michael A Morris
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Moozhan Nikpanah
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Elizabeth C Jones
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
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17
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Borja AJ, Rojulpote C, Hancin EC, Høilund-Carlsen PF, Alavi A. An Update on the Role of Total-Body PET Imaging in the Evaluation of Atherosclerosis. PET Clin 2020; 15:477-485. [DOI: 10.1016/j.cpet.2020.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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18
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Paydary K, Revheim ME, Emamzadehfard S, Gholami S, Pourhassan S, Werner TJ, Høilund-Carlsen PF, Alavi A. Quantitative thoracic aorta calcification assessment by 18F-NaF PET/CT and its correlation with atherosclerotic cardiovascular disorders and increasing age. Eur Radiol 2020; 31:785-794. [PMID: 32870396 DOI: 10.1007/s00330-020-07133-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/18/2020] [Accepted: 07/31/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We aimed to assess the correlation between age and cardiovascular risk factors with NaF-PET/CT imaging in the thoracic aorta (TA). METHODS In this prospective study, 80 healthy controls and 44 patients with chest pain underwent NaF-PET/CT imaging, and three segments of the aorta (ascending, arch, and descending) were examined. Average SUVmax, SUVmean, and Alavi-Carlsen Score (ACS) were calculated in each segment and the entire vessel. The degree of NaF uptake in controls and patients and its correlation with age were determined. Multivariate linear regression and logistic regression models were employed to determine the predictabilities of Framingham Risk Score (FRS) and unfavorable cardiovascular disease (CVD) risk profile by these measurements. RESULTS Average SUVmax, average SUVmean, and ACS were significantly higher in patients than in controls, and all correlated well with age. The correlation of average SUVmean with age was significant in both controls (r = 0.32, p = 0.04) and patients (r = 0.64, p < 0.001). ACS of the entire TA was a stronger predictor of FRS compared with average SUVmax and average SUVmean (adjusted R2 = 0.38, standardized β = 0.58, p < 0.001). ACS was a significant predictor of unfavorable CVD risk profile as compared with other values (odds ratio = 1.006, 95% CI = 1.000-1.013, p = 0.05). CONCLUSIONS Active calcification in TA correlates with age, and its correlation is higher among subjects with CVD risk factors. Global assessment (ACS) can predict unfavorable CVD risk profile. These data provide evidence for the potential role of NaF in assessing micro-calcification in arteries and its relations to cardiovascular events. KEY POINTS • Global micro-calcification in the thoracic aorta as measured by NaF-PET/CT imaging correlates with increasing age. • The extent of the correlation was higher among patients with cardiovascular disease (CVD) risk factors. • These data provide evidence for the potential role of NaF in assessing active calcification in arteries and its relations to cardiovascular events.
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Affiliation(s)
- Koosha Paydary
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sahra Emamzadehfard
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Saeid Gholami
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Sara Pourhassan
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | | | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.
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19
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Fusion and Healing Prediction in Posterolateral Spinal Fusion Using 18F-Sodium Fluoride-PET/CT. Diagnostics (Basel) 2020; 10:diagnostics10040226. [PMID: 32316237 PMCID: PMC7235917 DOI: 10.3390/diagnostics10040226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 01/02/2023] Open
Abstract
This study measures the total graft of 18F-sodium fluoride (NaF) uptake in non-instrumented posterolateral lumbar fusion (niPLF) patients one month after surgery and correlates it with the difference in the clinical findings between the baseline and one year after surgery. The walking distance (WLK-D), visual analog scale of back pain (VAS-B), VAS score of leg pain (VAS-L), tandem test (TAN), Oswestry Disability Index questionnaire (ODI), and European Quality of Life-5 Dimensions questionnaire (EQ-5D) were assessed before surgery and one year after. The graft NaF uptake was analyzed quantitatively with a fixed threshold algorithm resulting in the total graft uptake (SUVtotal) and partial volume corrected SUVtotal (cSUVtotal). Only 4 out of 18 patients experienced fusion; they had an insignificantly lower median total graft uptakes, i.e., 1178 SUVtotal vs. 1224 SUVtotal (p = 0.73) and 1282 cSUVtotal vs. 1231 cSUVtotal (p = 0.35), respectively. Similarly, fused patients experienced insignificantly larger pain decreases, i.e., median VAS-B 4.3 vs. 3.8 (p = 0.92) and VAS-L −6.4 vs. −4.4 (p = 0.2). We found an insignificant trend for a lower NaF uptake and less pain in fused patients. The NaF uptake did not correlate with the chronological change in the clinical parameters.
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20
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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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21
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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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Sorci O, Batzdorf AS, Mayer M, Rhodes S, Peng M, Jankelovits AR, Hornyak JN, Gerke O, Høilund-Carlsen PF, Alavi A, Rajapakse CS. 18F-sodium fluoride PET/CT provides prognostic clarity compared to calcium and Framingham risk scoring when addressing whole-heart arterial calcification. Eur J Nucl Med Mol Imaging 2019; 47:1678-1687. [DOI: 10.1007/s00259-019-04590-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/22/2019] [Indexed: 11/25/2022]
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23
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Al-Zaghal A, Yellanki DP, Kothekar E, Werner TJ, Høilund-Carlsen PF, Alavi A. Sacroiliac Joint Asymmetry Regarding Inflammation and Bone Turnover: Assessment by FDG and NaF PET/CT. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2019; 7:108-114. [PMID: 31380449 PMCID: PMC6661309 DOI: 10.22038/aojnmb.2019.40820.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives This study was undertaken to determine the role of computed tomography (CT)-based methodology to segment the SI joint and quantify the metabolic activity using positron emission tomography (PET). We measured tracer uptake in the right and left SI joints independently to look for differences between the two sides. Further, we correlated tracer uptake with BMI and studied the inter-observer variation with regard to estimated tracer uptake in the SI joints. Methods In this retrospective study, a total of 103 subjects (48 females, 55 males) from the CAMONA study database collected 2012-2016 at Odense University Hospital in Denmark were included. Mean age was 48±14.59 years, mean BMI was 26.68±4.31 kg/m2. The SI joints were segmented on fused PET/CT images using a 3D growing algorithm with adjustable upper and lower Hounsfield Units (HU) thresholds. The metabolic activities on the two sides were correlated with BMI. Results For FDG, we found a higher average SUVmean on the right side (right: 1.3±0.33, left: 1.13±0.30; <0.0001). Similarly, for NaF, the uptake was higher on the right side (right: 5.9±1.29, left: 4.27±1.23; <0.0001). Positive correlations were present between BMI and FDG uptake (P<0.01) as well as NaF uptake (P<0.01). Conclusion The PET-based molecular imaging probes along with the CT-based segmentation techniques revealed a significant difference in the metabolic activity between the two SI joints with higher inflammation and reactive bone formation on the right side. FDG and NaF uptakes correlated significantly and positively with BMI.
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Affiliation(s)
- Abdullah Al-Zaghal
- Department of Radiology, Hospital of the University of Pennsylvania, PA, USA
| | - Dani P Yellanki
- Department of Radiology, Hospital of the University of Pennsylvania, PA, USA
| | - Esha Kothekar
- Department of Radiology, Hospital of the University of Pennsylvania, PA, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, PA, USA
| | - Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, PA, USA
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24
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25
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Schmall JP, Karp JS, Alavi A. The Potential Role of Total Body PET Imaging in Assessment of Atherosclerosis. PET Clin 2019; 14:245-250. [PMID: 30826022 DOI: 10.1016/j.cpet.2018.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent advances in molecular imaging and PET instrumentation will be of great value in assessing atherosclerosis plaques and other cardiovascular disorders. Atherosclerosis is systemic and involves critical arteries. Total body PET imaging will allow assessment of disease throughout the body as well as therapeutic monitoring. Because of the high sensitivity of total body PET, delayed imaging can be performed hours after administering tracer compounds, resulting in higher contrast at the disease site. Global assessment of the plaque burden throughout the body will substantially improve our ability to quantify plaque activity in the course of the disease.
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Affiliation(s)
- Jeffrey P Schmall
- Department of Radiology, University of Pennsylvania, 3620 Hamilton Walk, 1st Floor John Morgan Building, Philadelphia, PA 19104, USA.
| | - Joel S Karp
- Department of Radiology, University of Pennsylvania, 3620 Hamilton Walk, 1st Floor John Morgan Building, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, 3620 Hamilton Walk, 1st Floor John Morgan Building, Philadelphia, PA 19104, USA
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26
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Høilund-Carlsen PF, Moghbel MC, Gerke O, Alavi A. Evolving Role of PET in Detecting and Characterizing Atherosclerosis. PET Clin 2019; 14:197-209. [DOI: 10.1016/j.cpet.2018.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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27
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Alavi A, Werner TJ, Høilund-Carlsen PF. What can be and what cannot be accomplished with PET to detect and characterize atherosclerotic plaques. J Nucl Cardiol 2018; 25:2012-2015. [PMID: 28695405 DOI: 10.1007/s12350-017-0977-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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28
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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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29
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Bellinge JW, Francis RJ, Majeed K, Watts GF, Schultz CJ. In search of the vulnerable patient or the vulnerable plaque: 18F-sodium fluoride positron emission tomography for cardiovascular risk stratification. J Nucl Cardiol 2018; 25:1774-1783. [PMID: 29992525 DOI: 10.1007/s12350-018-1360-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) remains a leading cause of death. Preventative therapies that reduce CVD are most effective when targeted to individuals at high risk. Current risk stratification tools have only modest prognostic capabilities, resulting in over-treatment of low-risk individuals and under-treatment of high-risk individuals. Improved methods of CVD risk stratification are required. Molecular imaging offers a novel approach to CVD risk stratification. In particular, 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) has shown promise in the detection of both high-risk atherosclerotic plaque features and vascular calcification activity, which predicts future development of new vascular calcium deposits. The rate of change of coronary calcium scores, measured by serial computed tomography scans over a 2-year period, is a strong predictor of CVD risk. Vascular calcification activity, as measured with 18F-NaF PET, has the potential to provide prognostic information similar to consecutive coronary calcium scoring, with a single-time-point convenience. However, owing to the rapid motion and small size of the coronary arteries, new solutions are required to address the traditional limitations of PET imaging. Two different methods of coronary PET analysis have been independently proposed and here we compare their respective strengths, weaknesses, and the potential for clinical translation.
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Affiliation(s)
- Jamie W Bellinge
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia.
- School of Medicine, University of Western Australia, Perth, Australia.
| | - Roslyn J Francis
- School of Medicine, University of Western Australia, Perth, Australia
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Gerald F Watts
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Carl J Schultz
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
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Kwiecinski J, Berman DS, Lee SE, Dey D, Cadet S, Lassen ML, Germano G, Jansen MA, Dweck MR, Newby DE, Chang HJ, Yun M, Slomka PJ. Three-Hour Delayed Imaging Improves Assessment of Coronary 18F-Sodium Fluoride PET. J Nucl Med 2018; 60:530-535. [PMID: 30213848 DOI: 10.2967/jnumed.118.217885] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/05/2018] [Indexed: 01/26/2023] Open
Abstract
Coronary 18F-sodium fluoride (18F-NaF) PET identifies ruptured plaques in patients with recent myocardial infarction and localizes to atherosclerotic lesions with active calcification. Most studies to date have performed the PET acquisition 1 h after injection. Although qualitative and semiquantitative analysis is feasible with 1-h images, residual blood-pool activity often makes it difficult to discriminate plaques with 18F-NaF uptake from noise. We aimed to assess whether delayed PET performed 3 h after injection improves image quality and uptake measurements. Methods: Twenty patients (67 ± 7 y old, 55% male) with stable coronary artery disease underwent coronary CT angiography (CTA) and PET/CT both 1 h and 3 h after the injection of 266.2 ± 13.3 MBq of 18F-NaF. We compared the visual pattern of coronary uptake, maximal background (blood pool) activity, noise, SUVmax, corrected SUVmax (cSUVmax), and target-to-background (TBR) ratio in lesions defined by CTA on 1-h versus 3-h 18F-NaF PET. Results: On 1-h PET, 26 CTA lesions with 18F-NaF PET uptake were identified in 12 (60%) patients. On 3-h PET, we detected 18F-NaF PET uptake in 7 lesions that were not identified on 1-h PET. The median cSUVmax and TBRs of these lesions were 0.48 (interquartile range [IQR], 0.44-0.51) and 1.45 (IQR, 1.39-1.52), respectively, compared with -0.01 (IQR, -0.03-0.001) and 0.95 (IQR, 0.90-0.98), respectively, on 1-h PET (both P < 0.001). Across the entire cohort, 3-h PET SUVmax was similar to 1-h PET measurements (1.63 [IQR, 1.37-1.98] vs. 1.55 [IQR, 1.43-1.89], P = 0.30), and the background activity was lower (0.71 [IQR, 0.65-0.81] vs. 1.24 [IQR, 1.05-1.31], P < 0.001). On 3-h PET, TBR, cSUVmax, and noise were significantly higher (respectively: 2.30 [IQR, 1.70-2.68] vs. 1.28 [IQR, 0.98-1.56], P < 0.001; 0.38 [IQR, 0.27-0.70] vs. 0.90 [IQR, 0.64-1.17], P < 0.001; and 0.10 [IQR, 0.09-0.12] vs. 0.07 [IQR, 0.06-0.09], P = 0.02). Median cSUVmax and TBR increased by 92% (range, 33%-225%) and 80% (range, 20%-177%), respectively. Conclusion: Blood-pool activity decreases on delayed imaging, facilitating the assessment of 18F-NaF uptake in coronary plaques. Median TBR increases by 80%, leading to the detection of more plaques with significant uptake than are detected using the standard 1-h protocol. A greater than 1-h delay may improve the detection of 18F-NaF uptake in coronary artery plaques.
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Affiliation(s)
- Jacek Kwiecinski
- Cedars-Sinai Medical Center, Los Angeles, California.,BHF Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, United Kingdom; and
| | | | - Sang-Eun Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Guido Germano
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Maurits A Jansen
- BHF Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, United Kingdom; and
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, United Kingdom; and
| | - David E Newby
- BHF Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, United Kingdom; and
| | - Hyuk-Jae Chang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Mijin Yun
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Al-Zaghal A, Mehdizadeh Seraj S, Werner TJ, Gerke O, Høilund-Carlsen PF, Alavi A. Assessment of Physiological Intracranial Calcification in Healthy Adults Using 18F-NaF PET/CT. J Nucl Med 2018; 60:jnumed.118.213678. [PMID: 30002111 DOI: 10.2967/jnumed.118.213678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/18/2018] [Indexed: 11/16/2022] Open
Abstract
The aim of this research study was to determine the role of 18F-Sodium fluoride (NaF) PET/CT imaging in the assessment of physiologic molecular calcification in the intra-cranial structures. We also examined the association of NaF accumulation with age as well as Hounsfield unit (HU) in certain anatomical sites that are known to calcify with normal aging. Methods: A total of 78 healthy subjects from the Cardiovascular Molecular Calcification Assessed by 18F-NaF PET/CT (CAMONA) clinical trial (38 females and 40 males) were included in this retrospective study. The mean age was 45.28 ±14.15 years (21-75). Mean standardized uptake values (SUVmean) was used to measure NaF accumulation in the choroid plexus and epithalamus (pineal gland and habenula). Maximum HU was also measured for each ROI. Correlation analysis was conducted to assess the association between parameters. Results: Mean SUVmean was 0.42 ± 0.26 in the right choroid plexus, 0.39 ±25 in the left choroid plexus, and 0.23±0.08 in the epithalamus. Significant positive correlations were present between NaF uptake and age in the right choroid plexus (r=0.61, P < 0.0001), left choroid plexus (r=0.63, p<0.0001), and epithalamus (r=0.36, P = 0.001). NaF uptake significantly correlated with HU in the right choroid plexus (r=0.52, P < 0.0001), left choroid plexus (r=0.57, p<0.0001), and epithalamus (r=0.25, P = 0.03). Conclusion: NaF could be used in the assessment of physiological calcification in several intracranial structures. We report significant associations between NaF uptake and aging as well as HU in the calcified choroid plexus and epithalamus. Our findings further support the growing interest to utilize NaF for detecting extra-osseous, molecular calcification, and this powerful probe has potential applications in the evaluation of various age-related, neurodegenerative brain processes.
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Affiliation(s)
| | | | | | | | | | - Abass Alavi
- Hospital of the University of Pennsylvania, United States
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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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Coronary fluorine-18-sodium fluoride uptake is increased in healthy adults with an unfavorable cardiovascular risk profile: results from the CAMONA study. Nucl Med Commun 2018; 38:1007-1014. [PMID: 28877084 DOI: 10.1097/mnm.0000000000000734] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Coronary artery fluorine-18-sodium fluoride (F-NaF) uptake reflects coronary artery calcification metabolism and is considered to be an early prognostic marker of coronary heart disease. This study evaluated the relationship between coronary artery F-NaF uptake and cardiovascular risk in healthy adults at low cardiovascular risk. PARTICIPANTS AND METHODS Study participants underwent blood pressure measurements, blood analyses, and coronary artery F-NaF PET/CT imaging. In addition, the 10-year risk for the development of cardiovascular disease, on the basis of the Framingham Risk Score, was estimated. Multivariable linear regression evaluated the dependence of coronary artery F-NaF uptake on cardiovascular risk factors. RESULTS We recruited 89 (47 men, 42 women) healthy adults aged 21-75 years. Female sex (0.34 kBq/ml; P=0.009), age (0.16 kBq/ml per SD; P=0.002), and BMI (0.42 kBq/ml per SD; P<0.001) were independent determinants of increased coronary artery F-NaF uptake (adjusted R=0.21; P<0.001). Coronary artery F-NaF uptake increased linearly according to the number of cardiovascular risk factors present (P<0.001 for a linear trend). The estimated 10-year risk for the development of cardiovascular disease was on average 2.4 times higher in adults with coronary artery F-NaF uptake in the highest quartile compared with those in the lowest quartile of the distribution (8.0 vs. 3.3%, P<0.001). CONCLUSION Our findings indicate that coronary artery F-NaF PET/CT imaging is feasible in healthy adults at low cardiovascular risk and that an unfavorable cardiovascular risk profile is associated with a marked increase in coronary artery F-NaF uptake.
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Reference values for fluorine-18-fluorodeoxyglucose and fluorine-18-sodium fluoride uptake in human arteries: a prospective evaluation of 89 healthy adults. Nucl Med Commun 2018; 38:998-1006. [PMID: 28902094 DOI: 10.1097/mnm.0000000000000748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Reference values of fluorine-18-fluorodeoxyglucose (F-FDG) and fluorine-18-sodium fluoride (F-NaF) uptake in human arteries are unknown. The aim of this study was to determine age-specific and sex-specific reference values of arterial F-FDG and F-NaF uptake. PARTICIPANTS AND METHODS Uptake of F-FDG and F-NaF was determined in the ascending aorta, aortic arch, and descending thoracic aorta. In addition, F-FDG uptake was determined in the carotid arteries and F-NaF uptake was determined in the coronary arteries. Arterial F-FDG and F-NaF uptake were quantified as the blood pool subtracted maximum activity concentration in kBq/ml (BS F-FDGmax and BS F-NaFmax, respectively). In addition to determining reference values, we evaluated the influence of age and sex on BS F-FDGmax and BS F-NaFmax. RESULTS Arterial F-FDG and F-NaF uptake was assessed in 89 healthy adults aged 21-75 years (mean age: 44±14 years, 53% men). Both BS F-FDGmax and BS F-NaFmax increased with age. BS F-FDGmax increased with age in the descending aorta (β=0.28; P=0.003), whereas BS F-NaFmax increased with age in the ascending aorta (β=0.18; P<0.001), aortic arch (β=0.19; P=0.006), descending aorta (β=0.33; P<0.001), and coronary arteries (β=0.20; P=0.009), respectively. BS F-FDGmax and BS F-NaFmax were not influenced by sex, except for BS F-FDGmax in the ascending aorta. CONCLUSION Prospective evaluation of 89 healthy adults generated age-specific and sex-specific reference values of arterial F-FDG and F-NaF uptake. Our findings indicate that arterial F-FDG and F-NaF uptake tend to increase with age.
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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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36
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Thoracic aorta calcification but not inflammation is associated with increased cardiovascular disease risk: results of the CAMONA study. Eur J Nucl Med Mol Imaging 2016; 44:249-258. [PMID: 27796543 PMCID: PMC5214929 DOI: 10.1007/s00259-016-3552-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/11/2016] [Indexed: 12/21/2022]
Abstract
Purpose Arterial inflammation and vascular calcification are regarded as early prognostic markers of cardiovascular disease (CVD). In this study we investigated the relationship between CVD risk and arterial inflammation (18F-FDG PET/CT imaging), vascular calcification metabolism (Na18F PET/CT imaging), and vascular calcium burden (CT imaging) of the thoracic aorta in a population at low CVD risk. Methods Study participants underwent blood pressure measurements, blood analyses, and 18F-FDG and Na18F PET/CT imaging. In addition, the 10-year risk for development of CVD, based on the Framingham risk score (FRS), was estimated. CVD risk was compared across quartiles of thoracic aorta 18F-FDG uptake, Na18F uptake, and calcium burden on CT. Results A total of 139 subjects (52 % men, mean age 49 years, age range 21 – 75 years, median FRS 6 %) were evaluated. CVD risk was, on average, 3.7 times higher among subjects with thoracic aorta Na18F uptake in the highest quartile compared with those in the lowest quartile of the distribution (15.5 % vs. 4.2 %; P < 0.001). CVD risk was on average, 3.7 times higher among subjects with a thoracic aorta calcium burden on CT in the highest quartile compared with those in the lowest two quartiles of the distribution (18.0 % vs. 4.9 %; P < 0.001). CVD risk was similar in subjects in all quartiles of thoracic aorta 18F-FDG uptake. Conclusion Our findings indicate that an unfavourable CVD risk profile is associated with marked increases in vascular calcification metabolism and vascular calcium burden of the thoracic aorta, but not with arterial inflammation. Electronic supplementary material The online version of this article (doi:10.1007/s00259-016-3552-9) contains supplementary material, which is available to authorized users.
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Scherer DJ, Psaltis PJ. Future imaging of atherosclerosis: molecular imaging of coronary atherosclerosis with (18)F positron emission tomography. Cardiovasc Diagn Ther 2016; 6:354-67. [PMID: 27500093 DOI: 10.21037/cdt.2015.12.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Atherosclerosis is characterized by the formation of complex atheroma lesions (plaques) in arteries that pose risk by their flow-limiting nature and propensity for rupture and thrombotic occlusion. It develops in the context of disturbances to lipid metabolism and immune response, with inflammation underpinning all stages of plaque formation, progression and rupture. As the primary disease process responsible for myocardial infarction, stroke and peripheral vascular disease, atherosclerosis is a leading cause of morbidity and mortality on a global scale. A precise understanding of its pathogenic mechanisms is therefore critically important. Integral to this is the role of vascular wall imaging. Over recent years, the rapidly evolving field of molecular imaging has begun to revolutionize our ability to image beyond just the anatomical substrate of vascular disease, and more dynamically assess its pathobiology. Nuclear imaging by positron emission tomography (PET) can target specific molecular and biological pathways involved in atherosclerosis, with the application of (18)Fluoride PET imaging being widely studied for its potential to identify plaques that are vulnerable or high risk. In this review, we discuss the emergence of (18)Fluoride PET as a promising modality for the assessment of coronary atherosclerosis, focusing on the strengths and limitations of the two main radionuclide tracers that have been investigated to date: 2-deoxy-2-((18)F)fluoro-D-glucose ((18)F-FDG) and sodium (18)F-fluoride ((18)F-NaF).
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Affiliation(s)
- Daniel J Scherer
- Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia 5000, Australia;; Royal Adelaide Hospital, South Australia 5000, Australia; ; School of Medicine, The University of Adelaide, South Australia 5000, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia 5000, Australia;; Royal Adelaide Hospital, South Australia 5000, Australia; ; School of Medicine, The University of Adelaide, South Australia 5000, Australia
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Blomberg BA, Thomassen A, de Jong PA, Simonsen JA, Lam MGEH, Nielsen AL, Mickley H, Mali WPTM, Alavi A, Høilund-Carlsen PF. Impact of Personal Characteristics and Technical Factors on Quantification of Sodium 18F-Fluoride Uptake in Human Arteries: Prospective Evaluation of Healthy Subjects. J Nucl Med 2015. [PMID: 26205304 DOI: 10.2967/jnumed.115.159798] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED Sodium 18F-fluoride (18F-NaF) PET/CT imaging is a promising imaging technique for the assessment of atherosclerosis but is hampered by a lack of validated quantification protocols. Both personal characteristics and technical factors can affect quantification of arterial 18F-NaF uptake. This study investigated whether blood activity, renal function, injected dose, circulating time, and PET/CT system affect quantification of arterial 18F-NaF uptake. METHODS Eighty-nine healthy subjects were prospectively examined by 18F-NaF PET/CT imaging. Arterial 18F-NaF uptake was quantified at the level of the ascending aorta, aortic arch, descending thoracic aorta, and coronary arteries by calculating the maximum 18F-NaF activity (NaFmax), the maximum/mean target-to-background ratio (TBRmax/mean), and the maximum blood-subtracted 18F-NaF activity (bsNaFmax). Multivariable linear regression assessed the effect of personal characteristics and technical factors on quantification of arterial 18F-NaF uptake. RESULTS NaFmax and TBRmax/mean were dependent on blood activity (β=0.34 to 0.44, P<0.001, and β=-0.68 to -0.58, P<0.001, respectively) and PET/CT system (β=-0.80 to -0.53, P<0.001, and β=-0.80 to -0.23, P<0.031, respectively). bsNaFmax depended on PET/CT system (β=-0.91 to -0.57, P<0.001) but not blood activity. This finding was observed at the level of the ascending aorta, aortic arch, descending thoracic aorta, and the coronary arteries. In addition to blood activity and PET/CT system, injected dose affected quantification of arterial 18F-NaF uptake, whereas renal function and circulating time did not. CONCLUSION The prospective evaluation of 89 healthy subjects demonstrated that quantification of arterial 18F-NaF uptake is affected by blood activity, injected dose, and PET/CT system. Therefore, blood activity, injected dose, and PET/CT system should be considered to generate accurate estimates of arterial 18F-NaF uptake.
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Affiliation(s)
- Björn Alexander Blomberg
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anders Thomassen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Pim A de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jane A Simonsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne L Nielsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Willem P T M Mali
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Derlin T, Janssen T, Salamon J, Veldhoen S, Busch JD, Schön G, Herrmann J, Henes FO, Bannas P, Adam G. Age-related differences in the activity of arterial mineral deposition and regional bone metabolism: a 18F-sodium fluoride positron emission tomography study. Osteoporos Int 2015; 26:199-207. [PMID: 25124219 DOI: 10.1007/s00198-014-2839-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/31/2014] [Indexed: 01/08/2023]
Abstract
UNLABELLED Functional (18)F-fluoride PET demonstrated an inverse relationship between the activity of arterial mineral deposition and regional bone metabolism. While bone metabolism decreases with age, the activity of arterial mineral deposition increases. INTRODUCTION The extent of arterial calcification increases with age, whereas bone mineral density decreases, evidencing a well-known inverse correlation on morphological basis. The aim of this study was to evaluate the functional relationship between the activity of arterial mineral deposition and regional bone metabolism as assessed by (18)F-sodium fluoride (NaF) PET/CT. METHODS Three hundred four subjects were examined by (18)F-NaF PET/CT. Tracer accumulation in the femoral arteries was analyzed both qualitatively and semiquantitatively by measuring the blood-pool-corrected standardized uptake value (target-to-background ratio). Uptake was compared with cardiovascular risk factors (RFs), calcified plaque burden, and regional bone metabolism as assessed by PET/CT. RESULTS The activity of arterial mineral deposition significantly increased with age (p < 0.001), whereas regional bone metabolism significantly decreased (p < 0.001). There was a significant inverse correlation between bone metabolism and arterial mineral deposition (unadjusted, p < 0.001); that association was not significant (p = 0.79) when controlled for age and other RFs. Both high activity of arterial mineral deposition and low bone metabolism were significantly associated with cardiovascular events and other RFs. CONCLUSION (18)F-NaF PET/CT provides a tool to visualize and quantify the activity of arterial mineral deposition and regional bone metabolism. In this study, we observed an inverse correlation between the activity of arterial mineral deposition and regional bone metabolism. While the activity of arterial mineral deposition significantly increases with age, regional bone metabolism decreases.
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Affiliation(s)
- T Derlin
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
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