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Nash J, Debono S, Whittington B, Kaczynski J, Clark T, Macnaught G, Semple S, van Beek EJR, Tavares A, Dey D, Williams MC, Slomka PJ, Newby DE, Dweck MR, Fletcher AJ. Thoracic aortic microcalcification activity in combined positron emission tomography and magnetic resonance imaging. Eur J Nucl Med Mol Imaging 2024; 51:2260-2270. [PMID: 38456972 PMCID: PMC11178619 DOI: 10.1007/s00259-024-06670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Non-invasive detection of pathological changes in thoracic aortic disease remains an unmet clinical need particularly for patients with congenital heart disease. Positron emission tomography combined with magnetic resonance imaging (PET-MRI) could provide a valuable low-radiation method of aortic surveillance in high-risk groups. Quantification of aortic microcalcification activity using sodium [18F]fluoride holds promise in the assessment of thoracic aortopathies. We sought to evaluate aortic sodium [18F]fluoride uptake in PET-MRI using three methods of attenuation correction compared to positron emission tomography computed tomography (PET-CT) in patients with bicuspid aortic valve, METHODS: Thirty asymptomatic patients under surveillance for bicuspid aortic valve disease underwent sodium [18F]fluoride PET-CT and PET-MRI of the ascending thoracic aorta during a single visit. PET-MRI data were reconstructed using three iterations of attenuation correction (Dixon, radial gradient recalled echo with two [RadialVIBE-2] or four [RadialVIBE-4] tissue segmentation). Images were qualitatively and quantitatively analysed for aortic sodium [18F]fluoride uptake on PET-CT and PET-MRI. RESULTS Aortic sodium [18F]fluoride uptake on PET-MRI was visually comparable with PET-CT using each reconstruction and total aortic standardised uptake values on PET-CT strongly correlated with each PET-MRI attenuation correction method (Dixon R = 0.70; RadialVIBE-2 R = 0.63; RadialVIBE-4 R = 0.64; p < 0.001 for all). Breathing related artefact between soft tissue and lung were detected using Dixon and RadialVIBE-4 but not RadialVIBE-2 reconstructions, with the presence of this artefact adjacent to the atria leading to variations in blood pool activity estimates. Consequently, quantitative agreements between radiotracer activity on PET-CT and PET-MRI were most consistent with RadialVIBE-2. CONCLUSION Ascending aortic microcalcification analysis in PET-MRI is feasible with comparable findings to PET-CT. RadialVIBE-2 tissue attenuation correction correlates best with the reference standard of PET-CT and is less susceptible to artefact. There remain challenges in segmenting tissue types in PET-MRI reconstructions, and improved attenuation correction methods are required.
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Affiliation(s)
- Jennifer Nash
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Samuel Debono
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Beth Whittington
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jakub Kaczynski
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Tim Clark
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Gillian Macnaught
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Department of Medical Physics, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Scott Semple
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging Facility Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging Facility Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Adriana Tavares
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Damini Dey
- Departments of Medicine, Division of Artificial Intelligence) and Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, USA
| | - Michelle C Williams
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Piotr J Slomka
- Departments of Medicine, Division of Artificial Intelligence) and Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, Los Angeles, USA
| | - David E Newby
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Marc R Dweck
- The University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Alexander J Fletcher
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Onnis C, Virmani R, Kawai K, Nardi V, Lerman A, Cademartiri F, Scicolone R, Boi A, Congiu T, Faa G, Libby P, Saba L. Coronary Artery Calcification: Current Concepts and Clinical Implications. Circulation 2024; 149:251-266. [PMID: 38227718 PMCID: PMC10794033 DOI: 10.1161/circulationaha.123.065657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Coronary artery calcification (CAC) accompanies the development of advanced atherosclerosis. Its role in atherosclerosis holds great interest because the presence and burden of coronary calcification provide direct evidence of the presence and extent of coronary artery disease; furthermore, CAC predicts future events independently of concomitant conventional cardiovascular risk factors and to a greater extent than any other noninvasive biomarker of this disease. Nevertheless, the relationship between CAC and the susceptibility of a plaque to provoke a thrombotic event remains incompletely understood. This review summarizes the current understanding and literature on CAC. It outlines the pathophysiology of CAC and reviews laboratory, histopathological, and genetic studies, as well as imaging findings, to characterize different types of calcification and to elucidate their implications. Some patterns of calcification such as microcalcification portend increased risk of rupture and cardiovascular events and may improve prognosis assessment noninvasively. However, contemporary computed tomography cannot assess early microcalcification. Limited spatial resolution and blooming artifacts may hinder estimation of degree of coronary artery stenosis. Technical advances such as photon counting detectors and combination with nuclear approaches (eg, NaF imaging) promise to improve the performance of cardiac computed tomography. These innovations may speed achieving the ultimate goal of providing noninvasively specific and clinically actionable information.
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Affiliation(s)
- Carlotta Onnis
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD
| | - Kenji Kawai
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD
| | - Valentina Nardi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Roberta Scicolone
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
| | - Alberto Boi
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari Italy
| | - Terenzio Congiu
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Ospedale San Giovanni di Dio (Cagliari) 09100 ITALY
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Ospedale San Giovanni di Dio (Cagliari) 09100 ITALY
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
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3
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Tingen HSA, Tubben A, van 't Oever JH, Pastoor EM, van Zon PPA, Nienhuis HLA, van der Meer P, Slart RHJA. Positron emission tomography in the diagnosis and follow-up of transthyretin amyloid cardiomyopathy patients: A systematic review. Eur J Nucl Med Mol Imaging 2023; 51:93-109. [PMID: 37561144 PMCID: PMC10684414 DOI: 10.1007/s00259-023-06381-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/20/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Transthyretin (ATTR) amyloidosis is a progressive protein misfolding disease with frequent cardiac involvement. This review aims to determine the value of PET in diagnosis, assessment of disease progression or treatment response and its relation to clinical outcome in follow-up of ATTR amyloid cardiomyopathy (ATTR-CM) patients. METHODS Medline, Cochrane Library, Embase and Web of Science databases were searched, from the earliest date available until December 2022, for studies investigating the use of PET in ATTR-CM patients. Studies containing original data were included, except for case reports. Risk of bias was assessed by QUADAS-2. RESULTS Twenty-one studies were included in this systematic review, investigating five different tracers: carbon-11 Pittsburgh compound B ([11C]PIB), fluorine-18 Florbetaben ([18F]FBB), fluorine-18 Florbetapir ([18F]FBP), fluorine-18 Flutemetamol ([18F]FMM) and fluorine-18 Sodium Fluoride (Na[18F]F). In total 211 ATTR amyloidosis patients were included. A majority of studies concluded that [11C]PIB, [18F]FBP and Na[18F]F can distinguish ATTR amyloidosis patients from controls, and that [11C]PIB and Na[18F]F, but not [18F]FBP, can distinguish ATTR-CM patients from patients with cardiac light chain amyloidosis. Evidence on the performance of [18F]FBB and [18F]FMM was contradictory. No studies on the use of PET in follow-up were found. CONCLUSION [11C]PIB, Na[18F]F and [18F]FBP can be used to diagnose cardiac amyloidosis, although [18F]FBP may not be suitable for the distinction of different types of amyloid cardiomyopathy. No studies on PET in the follow-up of ATTR amyloidosis patients were found. Future research should focus on the use of these PET tracers in the follow-up of ATTR amyloidosis patients.
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Affiliation(s)
- H S A Tingen
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
- Amyloidosis Centre of Expertise, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
| | - A Tubben
- Amyloidosis Centre of Expertise, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - J H van 't Oever
- Amyloidosis Centre of Expertise, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - E M Pastoor
- Amyloidosis Centre of Expertise, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - P P A van Zon
- Amyloidosis Centre of Expertise, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - H L A Nienhuis
- Amyloidosis Centre of Expertise, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - P van der Meer
- Amyloidosis Centre of Expertise, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Amyloidosis Centre of Expertise, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
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Chesnais H, Bastin N, Miguez S, Kargilis D, Kalluri A, Terry A, Rajapakse CS. Predicting Fractures Using Vertebral 18F-NaF Uptake in Prostate Cancer Patients. J Bone Metab 2023; 30:329-337. [PMID: 38073266 PMCID: PMC10721380 DOI: 10.11005/jbm.2023.30.4.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Patients with prostate cancer tend to be at heightened risk for fracture due to bone metastases and treatment with androgen-deprivation therapy. Bone mineral density (BMD) derived from dual energy X-ray absorptiometry (DXA) is the standard for determining fracture risk in this population. However, BMD often fails to predict many osteoporotic fractures. Patients with prostate cancer also undergo 18F-sodium fluoride (18F-NaF)-positron emission tomography/computed tomography (PET/CT) to monitor metastases. The purpose of this study was to assess whether bone deposition, assessed by 18F-NaF uptake in 18F-NaF PET/CT, could predict incident fractures better than DXA- or CT-derived BMD in patients with prostate cancer. METHODS This study included 105 males with prostate cancer who had undergone full body 18F-NaF PET/CT. Standardized uptake value (SUVmean and SUVmax) and CT-derived Hounsfield units (HU), a correlate of BMD, were recorded for each vertebral body. The average SUVmean, SUVmax, and HU were calculated for cervical, thoracic, lumbar, and sacral areas. The t-test was used to assess significant differences between fracture and no-fracture groups. RESULTS The SUVmean and SUVmax values for the thoracic area were lower in the fracture group than in the no-fracture group. There was no significant difference in cervical, thoracic, lumbar or sacral HU between the 2 groups. CONCLUSIONS Our study reports that lower PET-derived non-metastatic bone deposition in the thoracic spine is correlated with incidence of fractures in patients with prostate cancer. CT-derived HU, a correlate of DXA-derived BMD, was not predictive of fracture risk. 18F-NaF PET/CT may provide important insight into bone quality and fracture risk.
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Affiliation(s)
- Helene Chesnais
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nikita Bastin
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sofia Miguez
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Kargilis
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anita Kalluri
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Terry
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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Chowdhury MM, Tarkin JM. Could imaging microcalcification activity improve abdominal aortic aneurysm risk stratification after intervention? Heart 2023; 109:1654-1656. [PMID: 37463734 DOI: 10.1136/heartjnl-2023-322814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Mohammed M Chowdhury
- Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Section of Cardiorespiratory Medicine, Victor Phillip Dahdaleh Heart & Lung Research Institute, Cambridge University, Cambridge, UK
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, Victor Phillip Dahdaleh Heart & Lung Research Institute, Cambridge University, Cambridge, UK
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Ahmad AA, Ghim M, Toczek J, Neishabouri A, Ojha D, Zhang Z, Gona K, Raza MZ, Jung JJ, Kukreja G, Zhang J, Guerrera N, Liu C, Sadeghi MM. Multimodality Imaging of Aortic Valve Calcification and Function in a Murine Model of Calcific Aortic Valve Disease and Bicuspid Aortic Valve. J Nucl Med 2023; 64:1487-1494. [PMID: 37321825 PMCID: PMC10478817 DOI: 10.2967/jnumed.123.265516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/25/2023] [Indexed: 06/17/2023] Open
Abstract
Calcific aortic valve disease (CAVD) is a prevailing disease with increasing occurrence and no known medical therapy. Dcbld2-/- mice have a high prevalence of bicuspid aortic valve (BAV), spontaneous aortic valve calcification, and aortic stenosis (AS). 18F-NaF PET/CT can detect the aortic valve calcification process in humans. However, its feasibility in preclinical models of CAVD remains to be determined. Here, we sought to validate 18F-NaF PET/CT for tracking murine aortic valve calcification and leveraged it to examine the development of calcification with aging and its interdependence with BAV and AS in Dcbld2-/- mice. Methods: Dcbld2-/- mice at 3-4 mo, 10-16 mo, and 18-24 mo underwent echocardiography, 18F-NaF PET/CT (n = 34, or autoradiography (n = 45)), and tissue analysis. A subset of mice underwent both PET/CT and autoradiography (n = 12). The aortic valve signal was quantified as SUVmax on PET/CT and as percentage injected dose per square centimeter on autoradiography. The valve tissue sections were analyzed by microscopy to identify tricuspid and bicuspid aortic valves. Results: The aortic valve 18F-NaF signal on PET/CT was significantly higher at 18-24 mo (P < 0.0001) and 10-16 mo (P < 0.05) than at 3-4 mo. Additionally, at 18-24 mo BAV had a higher 18F-NaF signal than tricuspid aortic valves (P < 0.05). These findings were confirmed by autoradiography, with BAV having significantly higher 18F-NaF uptake in each age group. A significant correlation between PET and autoradiography data (Pearson r = 0.79, P < 0.01) established the accuracy of PET quantification. The rate of calcification with aging was significantly faster for BAV (P < 0.05). Transaortic valve flow velocity was significantly higher in animals with BAV at all ages. Finally, there was a significant correlation between transaortic valve flow velocity and aortic valve calcification by both PET/CT (r = 0.55, P < 0.001) and autoradiography (r = 0.45, P < 0.01). Conclusion: 18F-NaF PET/CT links valvular calcification to BAV and aging in Dcbld2-/- mice and suggests that AS may promote calcification. In addition to addressing the pathobiology of valvular calcification, 18F-NaF PET/CT may be a valuable tool for evaluation of emerging therapeutic interventions in CAVD.
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Affiliation(s)
- Azmi A Ahmad
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Mean Ghim
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Jakub Toczek
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Afarin Neishabouri
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Devi Ojha
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Zhengxing Zhang
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Kiran Gona
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Muhammad Zawwad Raza
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Jae-Joon Jung
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Gunjan Kukreja
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Jiasheng Zhang
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Nicole Guerrera
- Yale Translational Research Imaging Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; and
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Mehran M Sadeghi
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut;
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Kwiecinski J, Kolossváry M, Tzolos E, Meah MN, Adamson PD, Joshi NV, Williams MC, van Beek EJR, Berman DS, Maurovich-Horvat P, Newby DE, Dweck MR, Dey D, Slomka PJ. Latent Coronary Plaque Morphology From Computed Tomography Angiography, Molecular Disease Activity on Positron Emission Tomography, and Clinical Outcomes. Arterioscler Thromb Vasc Biol 2023; 43:e279-e290. [PMID: 37165878 PMCID: PMC11006237 DOI: 10.1161/atvbaha.123.319332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Assessments of coronary disease activity with 18F-sodium fluoride positron emission tomography and radiomics-based precision coronary plaque phenotyping derived from coronary computed tomography angiography may enhance risk stratification in patients with coronary artery disease. We sought to investigate whether the prognostic information provided by these 2 approaches is complementary in the prediction of myocardial infarction. METHODS Patients with known coronary artery disease underwent coronary 18F-sodium fluoride positron emission tomography and coronary computed tomography angiography on a hybrid positron emission tomography/computed tomography scanner. Coronary 18F-NaF uptake was determined by the coronary microcalcification activity. We performed quantitative plaque analysis of coronary computed tomography angiography datasets and extracted 1103 radiomic features for each plaque. Using weighted correlation network analysis, we derived latent morphological features of coronary lesions which were aggregated to patient-level radiomics nomograms to predict myocardial infarction. RESULTS Among 260 patients with established coronary artery disease (age, 65±9 years; 83% men), 179 (69%) participants showed increased coronary 18F-NaF activity (coronary microcalcification activity>0). Over 53 (40-59) months of follow-up, 18 patients had a myocardial infarction. Using weighted correlation network analysis, we derived 15 distinct eigen radiomic features representing latent morphological coronary plaque patterns in an unsupervised fashion. Following adjustments for calcified, noncalcified, and low-density noncalcified plaque volumes and 18F-NaF coronary microcalcification activity, 4 radiomic features remained independent predictors of myocardial infarction (hazard ratio, 1.46 [95% CI, 1.03-2.08]; P=0.03; hazard ratio, 1.62 [95% CI, 1.04-2.54]; P=0.02; hazard ratio, 1.49 [95% CI, 1.07-2.06]; P=0.01; and hazard ratio, 1.50 (95% CI, 1.05-2.13); P=0.02). CONCLUSIONS In patients with established coronary artery disease, latent coronary plaque morphological features, quantitative plaque volumes, and disease activity on 18F-sodium fluoride positron emission tomography are additive predictors of myocardial infarction.
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Affiliation(s)
- Jacek Kwiecinski
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland (J.K.)
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary (M.K.)
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary (M.K.)
| | - Evangelos Tzolos
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Mohammed N Meah
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (P.D.A.)
| | - Nikhil V Joshi
- Bristol Heart Institute, University of Bristol, United Kingdom (N.V.J.)
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
- Edinburgh Imaging, Queens Medical Research Institute (E.J.R.v.B.), University of Edinburgh, United Kingdom
| | - Daniel S Berman
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary (P.M.-H.)
| | - David E Newby
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
| | - Piotr J Slomka
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
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Tzolos E, Bing R, Andrews J, MacAskill MG, Tavares AAS, Macnaught G, Clark T, Mills NL, Fujisawa T, Nash J, Dey D, Slomka PJ, Koglin N, Stephens AW, Deutsch MA, van Beek EJR, Williams MC, Hermann S, Hugenberg V, Dweck MR, Newby DE. Noninvasive In Vivo Coronary Artery Thrombus Imaging. JACC Cardiovasc Imaging 2023; 16:820-832. [PMID: 36526577 DOI: 10.1016/j.jcmg.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/16/2022] [Accepted: 10/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The diagnosis and management of myocardial infarction are increasingly complex, and establishing the presence of intracoronary thrombosis has major implications for both the classification and treatment of myocardial infarction. OBJECTIVES The aim of this study was to investigate whether positron emission tomographic (PET) and computed tomographic (CT) imaging could noninvasively detect in vivo thrombus formation in human coronary arteries using a novel glycoprotein IIb/IIIa receptor antagonist-based radiotracer, 18F-GP1. METHODS In a single-center observational case-control study, patients with or without acute myocardial infarction underwent coronary 18F-GP1 PET/CT angiography. Coronary artery 18F-GP1 uptake was assessed visually and quantified using maximum target-to-background ratios. RESULTS 18F-GP1 PET/CT angiography was performed in 49 patients with and 50 patients without acute myocardial infarction (mean age: 61 ± 9 years, 75% men). Coronary 18F-GP1 uptake was apparent in 39 of the 49 culprit lesions (80%) in patients with acute myocardial infarction. False negative results appeared to relate to time delays to scan performance and low thrombus burden in small-caliber distal arteries. On multivariable regression analysis, culprit vessel status was the only independent variable associated with higher 18F-GP1 uptake. Extracoronary cardiac 18F-GP1 findings included a high frequency of infarct-related intramyocardial uptake (35%) as well as left ventricular (8%) or left atrial (2%) thrombus. CONCLUSIONS Coronary 18F-GP1 PET/CT angiography is the first noninvasive selective technique to identify in vivo coronary thrombosis in patients with acute myocardial infarction. This novel approach can further define the role and location of thrombosis within the heart and has the potential to inform the diagnosis, management, and treatment of patients with acute myocardial infarction. (In-Vivo Thrombus Imaging With 18F-GP1, a Novel Platelet PET Radiotracer [iThrombus]; NCT03943966).
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Affiliation(s)
- Evangelos Tzolos
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Rong Bing
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jack Andrews
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark G MacAskill
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Adriana A S Tavares
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Gillian Macnaught
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Tim Clark
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Takeshi Fujisawa
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Nash
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine) and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine) and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Marcus-Andre Deutsch
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Sven Hermann
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Verena Hugenberg
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia Bochum, University Hospital of the Ruhr University, Bad Oeynhausen, Germany
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
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9
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Blach A, Kwiecinski J. The Role of Positron Emission Tomography in Advancing the Understanding of the Pathogenesis of Heart and Vascular Diseases. Diagnostics (Basel) 2023; 13:1791. [PMID: 37238275 PMCID: PMC10217133 DOI: 10.3390/diagnostics13101791] [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: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. For developing new therapies, a better understanding of the underlying pathology is required. Historically, such insights have been primarily derived from pathological studies. In the 21st century, thanks to the advent of cardiovascular positron emission tomography (PET), which depicts the presence and activity of pathophysiological processes, it is now feasible to assess disease activity in vivo. By targeting distinct biological pathways, PET elucidates the activity of the processes which drive disease progression, adverse outcomes or, on the contrary, those that can be considered as a healing response. Given the insights provided by PET, this non-invasive imaging technology lends itself to the development of new therapies, providing a hope for the emergence of strategies that could have a profound impact on patient outcomes. In this narrative review, we discuss recent advances in cardiovascular PET imaging which have greatly advanced our understanding of atherosclerosis, ischemia, infection, adverse myocardial remodeling and degenerative valvular heart disease.
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Affiliation(s)
- Anna Blach
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
- Nuclear Medicine Department, Voxel Diagnostic Center, 40-514 Katowice, Poland
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, 04-628 Warsaw, Poland
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10
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Li T, Wang Y, Tu WP. Vitamin K supplementation and vascular calcification: a systematic review and meta-analysis of randomized controlled trials. Front Nutr 2023; 10:1115069. [PMID: 37252246 PMCID: PMC10218696 DOI: 10.3389/fnut.2023.1115069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/06/2023] [Indexed: 05/31/2023] Open
Abstract
Background Vascular calcification (VC) is a complex process that has been linked to conditions including cardiovascular diseases and chronic kidney disease. There is an ongoing debate about whether vitamin K (VK) can effectively prevent VC. To assess the efficiency and safety of VK supplementation in the therapies of VC, we performed a systematic review and meta-analysis of recent studies. Methods We searched major databases, including PubMed, the Cochrane Library, Embase databases, and Web of Science up until August 2022. 14 randomized controlled trials (RCTs) describing the outcomes of treatment for VK supplementation with VC have been included out of 332 studies. The results were reported in the change of coronary artery calcification (CAC) scores, other artery and valve calcification, vascular stiffness, and dephospho-uncarboxylated matrix Gla protein (dp-ucMGP). The reports of severe adverse events were recorded and analyzed. Results We reviewed 14 RCTs, comprising a total of 1,533 patients. Our analysis revealed that VK supplementation has a significant effect on CAC scores, slowing down the progression of CAC [I2 = 34%, MD= -17.37, 95% CI (-34.18, -0.56), p = 0.04]. The study found that VK supplementation had a significant impact on dp-ucMGP levels, as compared to the control group, where those receiving VK supplementation had lower values [I2 = 71%, MD = -243.31, 95% CI (-366.08, -120.53), p = 0.0001]. Additionally, there was no significant difference in the adverse events between the groups [I2 = 31%, RR = 0.92, 95% CI (-0.79,1.07), p = 0.29]. Conclusion VK may have therapeutic potential for alleviating VC, especially CAC. However, more rigorously designed RCTs are required to verify the benefits and efficacy of VK therapy in VC.
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11
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Rotzinger DC, Qanadli SD, Fahrni G. Imaging the Vulnerable Carotid Plaque with CT: Caveats to Consider. Comment on Wang et al. Identification Markers of Carotid Vulnerable Plaques: An Update. Biomolecules 2022, 12, 1192. Biomolecules 2023; 13:biom13020397. [PMID: 36830766 PMCID: PMC9953174 DOI: 10.3390/biom13020397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
We read with great interest the review by Wang et al. entitled "Identification Markers of Carotid Vulnerable Plaques: An Update", recently published in Biomolecules [...].
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Affiliation(s)
- David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-21-314-44-75
| | - Salah D. Qanadli
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
- Riviera-Chablais Hospital, 1847 Rennaz, Switzerland
| | - Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
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12
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Kwiecinski J. Novel PET Applications and Radiotracers for Imaging Cardiovascular Pathophysiology. Cardiol Clin 2023; 41:129-139. [PMID: 37003671 DOI: 10.1016/j.ccl.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
PET allows the assessment of cardiovascular pathophysiology across a wide range of cardiovascular conditions. By imaging processes directly involved in disease progression and adverse events, such as inflammation and developing calcifications (microcalcifications), PET can not only enhance our understanding of cardiovascular disease, but also, as shown for 18F-sodium fluoride, has the potential to predict hard endpoints. In this review, the recent advances in disease activity assessment with cardiovascular PET, which provide hope that this promising technology could be leveraged in the clinical setting, shall be discussed.
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Affiliation(s)
- Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, KKiAI, Institute of Cardiology, Alpejska 42, Warsaw 04-628, Poland.
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13
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Gimelli A, Lakshmanan S, Della Tommasina V, Liga R. What Is New in Risk Assessment in Nuclear Cardiology? Cardiol Clin 2023; 41:197-205. [PMID: 37003677 DOI: 10.1016/j.ccl.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Nuclear cardiology techniques allow in-depth evaluation of cardiac patients. A body of literature has established the use of nuclear cardiology. The results obtained with traditional cameras have been reinforced by those obtained with a series of innovations that have revolutionized the field of nuclear cardiology. This article highlights the role of nuclear cardiology in the risk assessment of patients with cardiac disease and sheds light on advancements of nuclear imaging techniques in the cardiovascular field. Patient risk stratification has a key role in modern precision medicine. Nuclear cardiac imaging techniques may quantitatively investigate major disease mechanisms of different cardiac pathologies.
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14
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Atanasova Lazareva M, Kolevska K, Chochevska M, Velickovska M, Jolevski F, Ugrinska A, Janevik-Ivanovska E. Aseptic process validation of [18F]Sodium Fluoride radiopharmaceutical in-house production. MAKEDONSKO FARMACEVTSKI BILTEN 2023. [DOI: 10.33320/maced.pharm.bull.2022.68.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Sodium fluoride ([18F]NaF) is a PET radiopharmaceutical for vizualization of the skeletal system and microcalcification. In the originally designed in-house method, [18F]NaF is recovered in aqueous solution after cyclotron irradiation, sterilized by passage through a 0.22 µm sterile filter and dispensed under aseptic conditions. To ensure the microbiological safety of drugs produced under aseptic conditions, validation of aseptic procedures is always recommended. This is essential for radiopharmaceuticals because most of them are released for administration before any sterility test can be completed due to their radioactive nature.
This study reports the validation of the aseptic process applied to the internal production of [18F]NaF carried out in two phases: testing the number of viable microorganisms in radiopharmaceutical product prior to sterilization and process simulation studies (media fill tests). We found that all samples were sterile and the endotoxin concentration was well below the maximum acceptable level reported in the Ph Eur. monograph on [18F]NaF. The results confirmed that the entire production process of [18F]NaF can be carried out under strictly aseptic conditions following the validated procedures preserving the sterility of the final product.
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Affiliation(s)
- Marija Atanasova Lazareva
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Katerina Kolevska
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Maja Chochevska
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Maja Velickovska
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Filip Jolevski
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Ana Ugrinska
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Emilija Janevik-Ivanovska
- Faculty of Medical Sciences, Goce Delcev University, Krste Misirkov 10-A, 2000 Stip, North Macedonia
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15
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Chou TH, Rimmerman ET, Patel S, Wynveen MK, Eisert SN, Musini KN, Janse SA, Bobbey AJ, Sarac TP, Atway SA, Go MR, Stacy MR. Vessel-by-vessel analysis of lower extremity 18F-NaF PET/CT imaging quantifies diabetes- and chronic kidney disease-induced active microcalcification in patients with peripheral arterial disease. EJNMMI Res 2023; 13:3. [PMID: 36648583 PMCID: PMC9845537 DOI: 10.1186/s13550-023-00951-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Positron emission tomography (PET)/computed tomography (CT) imaging with fluorine-18 (18F)-sodium fluoride (NaF) provides assessment of active vascular microcalcification, but its utility for evaluating diabetes mellitus (DM)- and chronic kidney disease (CKD)-induced atherosclerosis in peripheral arterial disease (PAD) has not been comprehensively evaluated. This study sought to use 18F-NaF PET/CT to quantify and compare active microcalcification on an artery-by-artery basis in healthy subjects, PAD patients with or without DM, and PAD patients with or without CKD. Additionally, we evaluated the contributions of DM, CKD, statin use and established CT-detectable calcium to 18F-NaF uptake for each lower extremity artery. METHODS PAD patients (n = 48) and healthy controls (n = 8) underwent lower extremity 18F-NaF PET/CT imaging. Fused PET/CT images guided segmentation of arteries of interest (i.e., femoral-popliteal, anterior tibial, tibioperoneal trunk, posterior tibial, and peroneal) and quantification of 18F-NaF uptake. 18F-NaF uptake was assessed for each artery and compared between subject groups. Additionally, established calcium burden was quantified for each artery using CT calcium mass score. Univariate and multivariate analyses were performed to evaluate DM, CKD, statin use, and CT calcium mass as predictors of 18F-NaF uptake in PAD. RESULTS PAD patients with DM or CKD demonstrated significantly higher active microcalcification (i.e., 18F-NaF uptake) for all arteries when compared to PAD patients without DM or CKD. Univariate and multivariate analyses revealed that concomitant DM or CKD was associated with increased microcalcification for all arteries of interest and this increased disease risk remained significant after adjusting for patient age, sex, and body mass index. Statin use was only associated with decreased microcalcification for the femoral-popliteal artery in multivariate analyses. Established CT-detectable calcium was not significantly associated with 18F-NaF uptake for 4 out of 5 arteries of interest. CONCLUSIONS 18F-NaF PET/CT imaging quantifies vessel-specific active microcalcification in PAD that is increased in multiple lower extremity arteries by DM and CKD and decreased in the femoral-popliteal artery by statin use. 18F-NaF PET imaging is complementary to and largely independent of established CT-detectable arterial calcification. 18F-NaF PET/CT imaging may provide an approach for non-invasively quantifying vessel-specific responses to emerging anti-atherogenic therapies or CKD treatment in patients with PAD.
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Affiliation(s)
- Ting-Heng Chou
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Eleanor T. Rimmerman
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA ,grid.261331.40000 0001 2285 7943Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH USA
| | - Surina Patel
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Molly K. Wynveen
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Susan N. Eisert
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Kumudha Narayana Musini
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Sarah A. Janse
- grid.261331.40000 0001 2285 7943Center for Biostatistics, The Ohio State University, Columbus, OH USA
| | - Adam J. Bobbey
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, Columbus, OH USA
| | - Timur P. Sarac
- grid.261331.40000 0001 2285 7943Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH USA
| | - Said A. Atway
- grid.261331.40000 0001 2285 7943Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH USA
| | - Michael R. Go
- grid.261331.40000 0001 2285 7943Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH USA
| | - Mitchel R. Stacy
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA ,grid.261331.40000 0001 2285 7943Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH USA ,grid.261331.40000 0001 2285 7943Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH USA
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Jin R, Zhang H, Lin C, Guo J, Zou W, Chen Z, Liu H. Inhibition of miR338 rescues cleidocranial dysplasia in Runx2 mutant mice partially via the Hif1a-Vegfa axis. Exp Mol Med 2023; 55:69-80. [PMID: 36599929 PMCID: PMC9898552 DOI: 10.1038/s12276-022-00914-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 01/06/2023] Open
Abstract
Haploinsufficiency of Runt-related transcription factor-2 (RUNX2) is responsible for cleidocranial dysplasia (CCD), a rare hereditary disease with a range of defects, including delayed closure of the cranial sutures and short stature. Symptom-based treatments, such as a combined surgical-orthodontic approach, are commonly used to treat CCD patients. However, there have been few reports of treatments based on Runx2-specific regulation targeting dwarfism symptoms. Previously, we found that the miR338 cluster, a potential diagnostic and therapeutic target for postmenopausal osteoporosis, could directly target Runx2 during osteoblast differentiation in vitro. Here, we generated miR338-/-;Runx2+/- mice to investigate whether inhibition of miR338 could rescue CCD defects caused by Runx2 mutation in vivo. We found that the dwarfism phenotype caused by Runx2 haploinsufficiency was recovered in miR338-/-;Runx2+/- mice, with complete bone density restoration and quicker closure of fontanels. Single-cell RNA-seq analysis revealed that knockout of miR338 specifically rescued the osteoblast lineage priming ability of bone marrow stromal cells in Runx2+/- femurs, which was further confirmed by Osterix-specific conditional knockout of miR338 in Runx2+/- mice (OsxCre; miR338 fl/fl;Runx2+/-). Mechanistically, ablation of the miR338 cluster in Runx2+/- femurs directly rescued the Hif1a-Vegfa pathway in Runx2+/- osteoblasts, as proven by gene expression profiles and ChIP and Re-ChIP assays. Collectively, our data revealed the genetic interaction between Runx2 and the miR338 cluster during osteoblast differentiation and implied that the miR338 cluster could be a potential therapeutic target for CCD.
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Affiliation(s)
- Runze Jin
- grid.49470.3e0000 0001 2331 6153The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079 China
| | - Hanshu Zhang
- grid.49470.3e0000 0001 2331 6153The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079 China
| | - Chujiao Lin
- grid.49470.3e0000 0001 2331 6153The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079 China ,grid.168645.80000 0001 0742 0364Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605 USA
| | - Jinqiang Guo
- grid.49470.3e0000 0001 2331 6153The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079 China
| | - Weiguo Zou
- grid.410726.60000 0004 1797 8419State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Sciences, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Zhi Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, China.
| | - Huan Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, China. .,Department of Periodontology, School of Stomatology, Wuhan University, Wuhan, 430079, China. .,Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China.
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17
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Recent Advances in Cardiovascular Diseases Research Using Animal Models and PET Radioisotope Tracers. Int J Mol Sci 2022; 24:ijms24010353. [PMID: 36613797 PMCID: PMC9820417 DOI: 10.3390/ijms24010353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Cardiovascular diseases (CVD) is a collective term describing a range of conditions that affect the heart and blood vessels. Due to the varied nature of the disorders, distinguishing between their causes and monitoring their progress is crucial for finding an effective treatment. Molecular imaging enables non-invasive visualisation and quantification of biological pathways, even at the molecular and subcellular levels, what is essential for understanding the causes and development of CVD. Positron emission tomography imaging is so far recognized as the best method for in vivo studies of the CVD related phenomena. The imaging is based on the use of radioisotope-labelled markers, which have been successfully used in both pre-clinical research and clinical studies. Current research on CVD with the use of such radioconjugates constantly increases our knowledge and understanding of the causes, and brings us closer to effective monitoring and treatment. This review outlines recent advances in the use of the so-far available radioisotope markers in the research on cardiovascular diseases in rodent models, points out the problems and provides a perspective for future applications of PET imaging in CVD studies.
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Kwiecinski J. Imaging coronary and aortic microcalcification activity with 18F-sodium fluoride. J Nucl Cardiol 2022; 29:3366-3368. [PMID: 35562638 DOI: 10.1007/s12350-022-02992-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
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19
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Figtree GA, Adamson PD, Antoniades C, Blumenthal RS, Blaha M, Budoff M, Celermajer DS, Chan MY, Chow CK, Dey D, Dwivedi G, Giannotti N, Grieve SM, Hamilton-Craig C, Kingwell BA, Kovacic JC, Min JK, Newby DE, Patel S, Peter K, Psaltis PJ, Vernon ST, Wong DT, Nicholls SJ. Noninvasive Plaque Imaging to Accelerate Coronary Artery Disease Drug Development. Circulation 2022; 146:1712-1727. [PMID: 36441819 DOI: 10.1161/circulationaha.122.060308] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
Coronary artery disease (CAD) remains the leading cause of adult mortality globally. Targeting known modifiable risk factors has had substantial benefit, but there remains a need for new approaches. Improvements in invasive and noninvasive imaging techniques have enabled an increasing recognition of distinct quantitative phenotypes of coronary atherosclerosis that are prognostically relevant. There are marked differences in plaque phenotype, from the high-risk, lipid-rich, thin-capped atheroma to the low-risk, quiescent, eccentric, nonobstructive calcified plaque. Such distinct phenotypes reflect different pathophysiologic pathways and are associated with different risks for acute ischemic events. Noninvasive coronary imaging techniques, such as computed tomography, positron emission tomography, and coronary magnetic resonance imaging, have major potential to accelerate cardiovascular drug development, which has been affected by the high costs and protracted timelines of cardiovascular outcome trials. This may be achieved through enrichment of high-risk phenotypes with higher event rates or as primary end points of drug efficacy, at least in phase 2 trials, in a manner historically performed through intravascular coronary imaging studies. Herein, we provide a comprehensive review of the current technology available and its application in clinical trials, including implications for sample size requirements, as well as potential limitations. In its effort to accelerate drug development, the US Food and Drug Administration has approved surrogate end points for 120 conditions, but not for CAD. There are robust data showing the beneficial effects of drugs, including statins, on CAD progression and plaque stabilization in a manner that correlates with established clinical end points of mortality and major adverse cardiovascular events. This, together with a clear mechanistic rationale for using imaging as a surrogate CAD end point, makes it timely for CAD imaging end points to be considered. We discuss the importance of global consensus on these imaging end points and protocols and partnership with regulatory bodies to build a more informed, sustainable staged pathway for novel therapies.
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Affiliation(s)
- Gemma A Figtree
- Kolling Institute of Medical Research, Sydney, Australia (G.A.F., S.T.V.)
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Australia (G.A.F., S.T.V.)
- Charles Perkins Centre (G.A.F., C.K.C.), University of Sydney, Australia
- Faculty of Medicine and Health (G.A.F., D.S.C., N.G., S.P., S.T.V.), University of Sydney, Australia
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago Christchurch, New Zealand (P.D.A.)
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (P.D.A., D.E.N.)
| | - Charalambos Antoniades
- Acute Vascular Imaging Centre (C.A.), Radcliffe Department of Medicine, University of Oxford, UK
- Division of Cardiovascular Medicine (C.A.), Radcliffe Department of Medicine, University of Oxford, UK
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (R.S.B., M. Blaha)
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (R.S.B., M. Blaha)
| | | | - David S Celermajer
- Faculty of Medicine and Health (G.A.F., D.S.C., N.G., S.P., S.T.V.), University of Sydney, Australia
- Departments of Cardiology (D.S.C., S.P.), Royal Prince Alfred Hospital, Sydney, Australia
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, Singapore (M.Y.C.)
| | - Clara K Chow
- Westmead Applied Research Centre (C.K.C.), University of Sydney, Australia
- Charles Perkins Centre (G.A.F., C.K.C.), University of Sydney, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.D.)
| | - Girish Dwivedi
- Harry Perkins Institute of Medical Research, University of Western Australia (G.D.)
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia (G.D.)
| | - Nicola Giannotti
- Faculty of Medicine and Health (G.A.F., D.S.C., N.G., S.P., S.T.V.), University of Sydney, Australia
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory (S.M.G.), University of Sydney, Australia
- Radiology (S.M.G.), Royal Prince Alfred Hospital, Sydney, Australia
| | - Christian Hamilton-Craig
- Faculty of Medicine and Centre for Advanced Imaging, University of Queensland and School of Medicine, Griffith University Sunshine Coast, Australia (C.H.-C.)
| | | | - Jason C Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (J.C.K.)
- St Vincent's Clinical School, University of NSW, Australia (J.C.K.)
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.C.K.)
| | | | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (P.D.A., D.E.N.)
| | - Sanjay Patel
- Faculty of Medicine and Health (G.A.F., D.S.C., N.G., S.P., S.T.V.), University of Sydney, Australia
- Departments of Cardiology (D.S.C., S.P.), Royal Prince Alfred Hospital, Sydney, Australia
| | - Karlheinz Peter
- Baker Heart and Diabetes Institute, Melbourne, Australia (K.P.)
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia (K.P.)
| | - Peter J Psaltis
- Lifelong Health, South Australian Health and Medical Research Institute, Adelaide (P.J.P.)
- Department of Cardiology, Royal Adelaide Hospital, Australia (P.J.P.)
| | - Stephen T Vernon
- Kolling Institute of Medical Research, Sydney, Australia (G.A.F., S.T.V.)
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Australia (G.A.F., S.T.V.)
- Faculty of Medicine and Health (G.A.F., D.S.C., N.G., S.P., S.T.V.), University of Sydney, Australia
| | - Dennis T Wong
- Monash Heart, Clayton, Australia (D.T.W., S.J.N.)
- Victorian Heart Institute, Monash University, Melbourne, Australia (D.T.W., S.J.N.)
| | - Stephen J Nicholls
- Monash Heart, Clayton, Australia (D.T.W., S.J.N.)
- Victorian Heart Institute, Monash University, Melbourne, Australia (D.T.W., S.J.N.)
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20
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Lassen ML, Tzolos E, Pan T, Kwiecinski J, Cadet S, Dey D, Berman D, Slomka P. Anatomical validation of automatic respiratory motion correction for coronary 18F-sodium fluoride positron emission tomography by expert measurements from four-dimensional computed tomography. Med Phys 2022; 49:7085-7094. [PMID: 35766454 PMCID: PMC9742185 DOI: 10.1002/mp.15834] [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: 10/21/2021] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Respiratory motion correction is of importance in studies of coronary plaques employing 18 F-NaF; however, the validation of motion correction techniques mainly relies on indirect measures such as test-retest repeatability assessments. In this study, we aim to compare and, thus, validate the respiratory motion vector fields obtained from the positron emission tomography (PET) images directly to the respiratory motion observed during four-dimensional cine-computed tomography (CT) by an expert observer. PURPOSE To investigate the accuracy of the motion correction employed in a software (FusionQuant) used for evaluation of 18 F-NaF PET studies by comparing the respiratory motion of the coronary plaques observed in PET to the respiratory motion observed in 4D cine-CT images. METHODS This study included 23 patients who undertook thoracic PET scans for the assessment of coronary plaques using 18 F-sodium fluoride (18 F-NaF). All patients underwent a 5-s cine-CT (4D-CT), a coronary CT angiography (CTA), and 18 F-NaF PET. The 4D-CT and PET scan were reconstructed into 10 phases. Respiratory motion was estimated for the non-contrast visible coronary plaques using diffeomorphic registrations (PET) and compared to respiratory motion observed on 4D-CT. We report the PET motion vector fields obtained in the three principal axes in addition to the 3D motion. Statistical differences were examined using paired t-tests. Signal-to-noise ratios (SNR) are reported for the single-phase images (end-expiratory phase) and for the motion-corrected image-series (employing the motion vector fields extracted during the diffeomorphic registrations). RESULTS In total, 19 coronary plaques were identified in 16 patients. No statistical differences were observed for the maximum respiratory motion observed in x, y, and the 3D motion fields (magnitude and direction) between the CT and PET (X direction: 4D CT = 2.5 ± 1.5 mm, PET = 2.4 ± 3.2 mm; Y direction: 4D CT = 2.3 ± 1.9 mm, PET = 0.7 ± 2.9 mm, 3D motion: 4D CT = 6.6 ± 3.1 mm, PET = 5.7 ± 2.6 mm, all p ≥ 0.05). Significant differences in respiratory motion were observed in the systems' Z direction: 4D CT = 4.9 ± 3.4 mm, PET = 2.3 ± 3.2 mm, p = 0.04. Significantly improved SNR is reported for the motion corrected images compared to the end-expiratory phase images (end-expiratory phase = 6.8±4.8, motion corrected = 12.2±4.5, p = 0.001). CONCLUSION Similar respiratory motion was observed in two directions and 3D for coronary plaques on 4D CT as detected by automatic respiratory motion correction of coronary PET using FusionQuant. The respiratory motion correction technique significantly improved the SNR in the images.
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Affiliation(s)
- Martin Lyngby Lassen
- Department of Imaging (Division of Nuclear Medicine), Medicine (Division of Artificial Intelligence in Medicine), and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Evangelos Tzolos
- Department of Imaging (Division of Nuclear Medicine), Medicine (Division of Artificial Intelligence in Medicine), and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA,BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tinsu Pan
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jacek Kwiecinski
- Department of Imaging (Division of Nuclear Medicine), Medicine (Division of Artificial Intelligence in Medicine), and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Sebastien Cadet
- Department of Imaging (Division of Nuclear Medicine), Medicine (Division of Artificial Intelligence in Medicine), and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging (Division of Nuclear Medicine), Medicine (Division of Artificial Intelligence in Medicine), and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Berman
- Department of Imaging (Division of Nuclear Medicine), Medicine (Division of Artificial Intelligence in Medicine), and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine (Division of Artificial Intelligence in Medicine), and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Dai M, Xu W, Chesnais H, Anabaraonye N, Parente J, Chatterjee S, Rajapakse CS. Atherogenic Indices as a Predictor of Aortic Calcification in Prostate Cancer Patients Assessed Using 18F-Sodium Fluoride PET/CT. Int J Mol Sci 2022; 23:13056. [PMID: 36361839 PMCID: PMC9653585 DOI: 10.3390/ijms232113056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
A major pathophysiological cause of cardiovascular disease is vascular plaque calcification. Fluorine 18−Sodium Fluoride (18F-NaF) PET/CT can be used as a sensitive imaging modality for detection of vascular calcification. The aim of this study was to find a non-invasive, cost-efficient, and readily available metric for predicting vascular calcification severity. This retrospective study was performed on 36 participants who underwent 18F-NaF fused PET/CT scans. The mean standard uptake values (SUVs) were calculated from manually sectioned axial sections over the aortic arch and thoracic aorta. Correlation analyses were performed between SUVs and calculated atherogenic indices (AIs). Castelli’s Risk Index I (r = 0.63, p < 0.0001), Castelli’s Risk Index II (r = 0.64, p < 0.0001), Atherogenic Coefficient (r = 0.63, p < 0.0001), Atherogenic Index of Plasma (r = 0.51, p = 0.00152), and standalone high-density lipoprotein (HDL) cholesterol (r = −0.53, p = 0.000786) were associated with aortic calcification. AIs show strong association with aortic arch and thoracic aorta calcifications. AIs are better predictors of vascular calcification compared to standalone lipid metrics, with the exception of HDL cholesterol. Clinical application of AIs provides a holistic metric beneficial for enhancing screening and treatment protocols.
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Affiliation(s)
- Michelle Dai
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
- College of Osteopathic Medicine, Touro University Nevada, 874 American Pacific Drive, Henderson, NV 89014, USA
| | - Winnie Xu
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Helene Chesnais
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Nancy Anabaraonye
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - James Parente
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Shampa Chatterjee
- Department of Physiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chamith S. Rajapakse
- Department of Radiology, University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
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22
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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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23
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Stendahl JC, Kwan JM, Pucar D, Sadeghi MM. Radiotracers to Address Unmet Clinical Needs in Cardiovascular Imaging, Part 2: Inflammation, Fibrosis, Thrombosis, Calcification, and Amyloidosis Imaging. J Nucl Med 2022; 63:986-994. [PMID: 35772956 PMCID: PMC9258561 DOI: 10.2967/jnumed.121.263507] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/22/2022] [Indexed: 01/03/2023] Open
Abstract
Cardiovascular imaging is evolving in response to systemwide trends toward molecular characterization and personalized therapies. The development of new radiotracers for PET and SPECT imaging is central to addressing the numerous unmet diagnostic needs that relate to these changes. In this 2-part review, we discuss select radiotracers that may help address key unmet clinical diagnostic needs in cardiovascular medicine. Part 1 examined key technical considerations pertaining to cardiovascular radiotracer development and reviewed emerging radiotracers for perfusion and neuronal imaging. Part 2 covers radiotracers for imaging cardiovascular inflammation, thrombosis, fibrosis, calcification, and amyloidosis. These radiotracers have the potential to address several unmet needs related to the risk stratification of atheroma, detection of thrombi, and the diagnosis, characterization, and risk stratification of cardiomyopathies. In the first section, we discuss radiotracers targeting various aspects of inflammatory responses in pathologies such as myocardial infarction, myocarditis, sarcoidosis, atherosclerosis, and vasculitis. In a subsequent section, we discuss radiotracers for the detection of systemic and device-related thrombi, such as those targeting fibrin (e.g., 64Cu-labeled fibrin-binding probe 8). We also cover emerging radiotracers for the imaging of cardiovascular fibrosis, such as those targeting fibroblast activation protein (e.g., 68Ga-fibroblast activation protein inhibitor). Lastly, we briefly review radiotracers for imaging of cardiovascular calcification (18F-NaF) and amyloidosis (e.g., 99mTc-pyrophosphate and 18F-florbetapir).
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Affiliation(s)
- John C Stendahl
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer M Kwan
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Darko Pucar
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut; and
| | - Mehran M Sadeghi
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut;
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
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24
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Debono S, Nash J, Fletcher AJ, Syed MBJ, Semple SI, van Beek EJR, Fletcher A, Cadet S, Williams MC, Dey D, Slomka PJ, Forsythe RO, Dweck MR, Newby DE. Quantifying sodium [ 18F]fluoride uptake in abdominal aortic aneurysms. EJNMMI Res 2022; 12:33. [PMID: 35666397 PMCID: PMC9170850 DOI: 10.1186/s13550-022-00904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Aortic microcalcification activity is a recently described method of measuring aortic sodium [18F]fluoride uptake in the thoracic aorta on positron emission tomography. In this study, we aimed to compare and to modify this method for use within the infrarenal aorta of patients with abdominal aortic aneurysms. METHODS Twenty-five patients with abdominal aortic aneurysms underwent an sodium [18F]fluoride positron emission tomography and computed tomography scan. Maximum and mean tissue-to-background ratios (TBR) and abdominal aortic microcalcification activity were determined following application of a thresholding and variable radius method to correct for vertebral sodium [18F]fluoride signal spill-over and the nonlinear changes in aortic diameter, respectively. Agreement between the methods, and repeatability of these approaches were assessed. RESULTS The aortic microcalcification activity method was much quicker to perform than the TBR method (14 versus 40 min, p < 0.001). There was moderate-to-good agreement between TBR and aortic microcalcification activity measurements for maximum (interclass correlation co-efficient, 0.67) and mean (interclass correlation co-efficient, 0.88) values. These correlations sequentially improved with the application of thresholding (intraclass correlation coefficient 0.93, 95% confidence interval 0.89-0.95) and variable diameter (intraclass correlation coefficient 0.97, 95% confidence interval 0.94-0.99) techniques. The optimised method had good intra-observer (mean 1.57 ± 0.42, bias 0.08, co-efficient of repeatability 0.36 and limits of agreement - 0.43 to 0.43) and inter-observer (mean 1.57 ± 0.42, bias 0.08, co-efficient of repeatability 0.47 and limits of agreement - 0.53 to 0.53) repeatability. CONCLUSIONS Aortic microcalcification activity is a quick and simple method which demonstrates good intra-observer and inter-observer repeatabilities and provides measures of sodium [18F]fluoride uptake that are comparable to established methods.
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Affiliation(s)
- Samuel Debono
- The University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Jennifer Nash
- The University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Alexander J Fletcher
- The University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Maaz B J Syed
- The University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Scott I Semple
- The University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Edwin J R van Beek
- The University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Alison Fletcher
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sebastien Cadet
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Centre, Biomedical Imaging Research Institute, Los Angeles, USA
| | - Michelle C Williams
- The University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Damini Dey
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Centre, Biomedical Imaging Research Institute, Los Angeles, USA
| | - Piotr J Slomka
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Centre, Biomedical Imaging Research Institute, Los Angeles, USA
| | - Rachael O Forsythe
- The University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Marc R Dweck
- The University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - David E Newby
- The University of Edinburgh Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
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Tawakol A, Mezue KN. Molecular Imaging in Acute Aortic Syndrome. JACC Cardiovasc Imaging 2022; 15:1305-1307. [DOI: 10.1016/j.jcmg.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 12/13/2022]
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Wen W, Gao M, Yun M, Meng J, Yu W, Zhu Z, Tian Y, Mou T, Zhang Y, Hacker M, Li S, Yu Y, Li X, Zhang X. In Vivo Coronary 18F-Sodium Fluoride Activity: Correlations With Coronary Plaque Histological Vulnerability and Physiological Environment. JACC. CARDIOVASCULAR IMAGING 2022; 16:508-520. [PMID: 36648038 DOI: 10.1016/j.jcmg.2022.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This prospective study aimed to evaluate the associations between in vivo coronary 18F-sodium fluoride (18F-NaF) positron emission tomography (PET)/computed tomography (CT) activity and ex vivo histological characteristics, to determine whether coronary 18F-NaF activity is a novel biomarker of plaque pathological vulnerability, and to explore the underlying physiological environment of 18F-NaF adsorption to vascular microcalcification. BACKGROUND 18F-NaF PET/CT is a promising new approach for assessing microcalcification in vascular plaque. METHODS Patients with coronary artery disease (CAD) underwent coronary computed tomography angiography (CTA) and 18F-NaF PET/CT. Histological vulnerability and immunohistochemical characteristics were evaluated in coronary endarterectomy (CE) specimens from patients who underwent coronary artery bypass grafting with adjunctive CE. Correlations between in-vivo coronary 18F-NaF activity with coronary CTA adverse plaque features and with ex vivo CE specimen morphological features, CD68 expression, inflammatory cytokines expression (tumor necrosis factor-α, interleukin-1β), osteogenic differentiation cytokines expression (osteopontin, runt-related transcription factor 2, osteocalcin) were evaluated. High- and low- to medium-risk plaques were defined by standard pathological classification. RESULTS A total of 55 specimens were obtained from 42 CAD patients. Coronary 18F-NaF activity of high-risk specimens was significantly higher than low- to medium-risk specimens (median [25th-75th percentile]: 1.88 [1.41-2.54] vs 1.12 [0.91-1.54]; P < 0.001). Coronary 18F-NaF activity showed high discriminatory accuracy in identifying high-risk plaque (AUC 0.80). Coronary CTA adverse plaque features (positive remodeling, low-attenuation plaque, remodeling index), histologically vulnerable features (large necrotic core, thin-fibro cap, microcalcification), CD68 expression, tumor necrosis factor-α expression, and interleukin-1β expression correlated with coronary 18F-NaF activity (all P < 0.05). No significant association between coronary 18F-NaF activity and osteogenic differentiation cytokines was found (all P > 0.05). CONCLUSIONS Coronary 18F-NaF activity was associated with histological vulnerability, CD68 expression, inflammatory cytokines expression, but not with osteogenic differentiation cytokines expression. 18F-NaF PET/CT imaging may provide a powerful tool for detecting high-risk coronary plaque and could improve the risk stratification of CAD patients.
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Affiliation(s)
- Wanwan Wen
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mingxin Gao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mingkai Yun
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingjing Meng
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ziwei Zhu
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Tian
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tiantian Mou
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yandong Zhang
- Department of Pathology, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Sijin Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Xiang Li
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
| | - Xiaoli Zhang
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Baolei G, Can C, Peng L, Yan S, Cheng Y, Hui T, Minzhi L, Daqiao G, Weiguo F. Molecular Imaging of Abdominal Aortic Aneurysms with Positron Emission Tomography: A Systematic Review. Eur J Vasc Endovasc Surg 2021; 62:969-980. [PMID: 34696984 DOI: 10.1016/j.ejvs.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/29/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Previous studies on the relationship between positron emission tomography (PET) images and abdominal aortic aneurysm (AAA) progression have shown contradictory results, and the objective of this study was to systematically review the role of PET in predicting AAA prognosis. DATA SOURCES PubMed, Embase, and Web of Science were searched for studies evaluating the correlation between PET imaging results and AAA growth, repair, or rupture. REVIEW METHODS Two authors independently performed the study search, data extraction, and quality assessment following a standard method. RESULTS Of the 11 studies included in this review, nine used 18F-fluorodeoxyglucose (18F-FDG) PET and computed tomography (CT) imaging, whereas the remaining two used 18F-sodium fluoride (18F-NaF) PET/CT and 18F-FDG PET/magnetic resonance imaging (MRI). Findings from the 18F-FDG PET/CT studies were contradictory. Six studies found no significant association or correlation, and two studies found a significant negative correlation between 18F-FDG uptake and AAA expansion. Additionally, one study found that the 18F-FDG uptake was statistically positively related to the expansion rate in a specific AAA subgroup whose AAAs expanded significantly. Two studies suggested that increased 18F-FDG uptake was significantly associated with AAA repair, while the other studies either found no association between 18F-FDG uptake and AAA rupture or repair or failed to report the occurrence of clinical events. One PET/CT study that used 18F-NaF as a tracer showed that an increased tracer uptake was significantly associated with AAA growth and clinical events. Finally, the 18F-FDG PET/MRI study indicated that 18F-FDG uptake was not significantly correlated with AAA expansion. CONCLUSION A definitive role for 18F-FDG PET imaging for AAA prognosis awaits further investigation, and new PET tracers such as 18F-NaF have the potential to be a promising method for predicting AAA clinical outcomes.
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Affiliation(s)
- Guo Baolei
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Chen Can
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lv Peng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shan Yan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Cheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tan Hui
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lv Minzhi
- Department of Medical Statistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo Daqiao
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Fu Weiguo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
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Pellico J, Fernández-Barahona I, Ruiz-Cabello J, Gutiérrez L, Muñoz-Hernando M, Sánchez-Guisado MJ, Aiestaran-Zelaia I, Martínez-Parra L, Rodríguez I, Bentzon J, Herranz F. HAP-Multitag, a PET and Positive MRI Contrast Nanotracer for the Longitudinal Characterization of Vascular Calcifications in Atherosclerosis. ACS APPLIED MATERIALS & INTERFACES 2021; 13:45279-45290. [PMID: 34529427 PMCID: PMC8485330 DOI: 10.1021/acsami.1c13417] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
Vascular microcalcifications are associated with atherosclerosis plaque instability and, therefore, to increased mortality. Because of this key role, several imaging probes have been developed for their in vivo identification. Among them, [18F]FNa is the gold standard, showing a large uptake in the whole skeleton by positron emission tomography. Here, we push the field toward the combined anatomical and functional early characterization of atherosclerosis. For this, we have developed hydroxyapatite (HAP)-multitag, a bisphosphonate-functionalized 68Ga core-doped magnetic nanoparticle showing high affinity toward most common calcium salts present in microcalcifications, particularly HAP. We characterized this interaction in vitro and in vivo, showing a massive uptake in the atherosclerotic lesion identified by positron emission tomography (PET) and positive contrast magnetic resonance imaging (MRI). In addition, this accumulation was found to be dependent on the calcification progression, with a maximum uptake in the microcalcification stage. These results confirmed the ability of HAP-multitag to identify vascular calcifications by PET/(T1)MRI during the vulnerable stages of the plaque progression.
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Affiliation(s)
- Juan Pellico
- CIBER
de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, St. Thomas’ Hospital, SE1 7EH London, U.K.
| | - Irene Fernández-Barahona
- Facultad
de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
- NanoMedMol
Group, Instituto de Química Medica (IQM), Consejo Superior
de Investigaciones Científicas (CSIC), 28006 Madrid, Spain
| | - Jesús Ruiz-Cabello
- CIBER
de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Facultad
de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), 20014 Donostia
San Sebastián, Spain
- IKERBASQUE,
Basque Foundation for Science, 48013 Bilbao, Spain
| | - Lucía Gutiérrez
- Departamento
de Química Analítica, Instituto
de Nanociencia y Materiales de Aragón, Universidad de Zaragoza-CSIC
y CIBER-BBN, 50018 Zaragoza, Spain
| | - María Muñoz-Hernando
- Centro
Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
- NanoMedMol
Group, Instituto de Química Medica (IQM), Consejo Superior
de Investigaciones Científicas (CSIC), 28006 Madrid, Spain
| | - María J. Sánchez-Guisado
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), 20014 Donostia
San Sebastián, Spain
| | - Irati Aiestaran-Zelaia
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), 20014 Donostia
San Sebastián, Spain
| | - Lydia Martínez-Parra
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), 20014 Donostia
San Sebastián, Spain
| | - Ignacio Rodríguez
- CIBER
de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Facultad
de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jacob Bentzon
- Centro
Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - Fernando Herranz
- CIBER
de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- NanoMedMol
Group, Instituto de Química Medica (IQM), Consejo Superior
de Investigaciones Científicas (CSIC), 28006 Madrid, Spain
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Cardiac hybrid imaging: novel tracers for novel targets. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:748-758. [PMID: 34659381 PMCID: PMC8501382 DOI: 10.11909/j.issn.1671-5411.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Non-invasive cardiac imaging has explored enormous advances in the last few decades. In particular, hybrid imaging represents the fusion of information from multiple imaging modalities, allowing to provide a more comprehensive dataset compared to traditional imaging techniques in patients with cardiovascular diseases. The complementary anatomical, functional and molecular information provided by hybrid systems are able to simplify the evaluation procedure of various pathologies in a routine clinical setting. The diagnostic capability of hybrid imaging modalities can be further enhanced by introducing novel and specific imaging biomarkers. The aim of this review is to cover the most recent advancements in radiotracers development for SPECT/CT, PET/CT, and PET/MRI for cardiovascular diseases.
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Nogales P, Velasco C, Mota-Cobián A, González-Cintado L, Mota RA, España S, Mateo J, Bentzon JF. Analysis of 18F-Sodium Fluoride Positron Emission Tomography Signal Sources in Atherosclerotic Minipigs Shows Specific Binding of 18F-Sodium Fluoride to Plaque Calcifications. Arterioscler Thromb Vasc Biol 2021; 41:e480-e490. [PMID: 34289703 DOI: 10.1161/atvbaha.121.316075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) imaging is thought to visualize active atherosclerotic plaque calcification. This is supported by the binding of 18F-NaF to plaque calcification ex vivo, but no prior studies have examined binding of 18F-NaF to human-like plaque in vivo. Our aim was to validate the specificity of 18F-NaF PET for plaque calcifications in atherosclerotic minipigs. Approach and Results: Gain-of-function PCSK9D374Y (proprotein convertase/subtilisin kexin type 9) transgenic Yucatan minipigs (n=4) were fed high-fat diet for 2.5 years to develop atherosclerosis and then subjected to 18F-NaF PET/computed tomography imaging. The heart, aorta, and iliac arteries were immediately re-scanned ex vivo after surgical extraction. Lesions from the abdominal aorta, iliac arteries, and coronary arteries were cryo-sectioned for autoradiography. Histological plaque characteristics, PET/computed tomography signal, and autoradiography were linked through regression and co-localization analysis. Arterial 18F-NaF PET signal had intensities comparable to clinical scans and colocalized moderately with calcification detected by computed tomography. Histological analysis showed calcification spanning from microcalcifications near lipid pools and necrotic core to more homogenous macrocalcifications. Comparison with arteries from autopsy cases confirmed the resemblance in localization and appearance with early human plaque calcification. Regression analysis in the abdominal aorta showed correlations with calcified plaque but could not rule out contributions from noncalcified plaque. This was resolved by autoradiography, which showed specific accumulation in plaque calcifications in all examined arteries. In the context of porcine abdominal aorta, 18F-NaF PET imaging was, however, less accurate than computed tomography for detecting small calcifications. CONCLUSIONS 18F-NaF accumulates specifically in calcifications of atherosclerotic plaques in vivo.
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Affiliation(s)
- Paula Nogales
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (P.N., C.V., A.M.-C., L.G.-C., R.A.M., S.E., J.M., J.F.B.)
| | - Carlos Velasco
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (P.N., C.V., A.M.-C., L.G.-C., R.A.M., S.E., J.M., J.F.B.)
| | - Adriana Mota-Cobián
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (P.N., C.V., A.M.-C., L.G.-C., R.A.M., S.E., J.M., J.F.B.).,Departamento de Estructura de la Materia, Física Térmica y Electrónica, Universidad Complutense de Madrid, IdISSC, Spain (A.M.-C., S.E.)
| | - Leticia González-Cintado
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (P.N., C.V., A.M.-C., L.G.-C., R.A.M., S.E., J.M., J.F.B.)
| | - Rubén Avelino Mota
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (P.N., C.V., A.M.-C., L.G.-C., R.A.M., S.E., J.M., J.F.B.).,Charles River Laboratories Spain, Sant-Cugat del Vallés (R.A.M.)
| | - Samuel España
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (P.N., C.V., A.M.-C., L.G.-C., R.A.M., S.E., J.M., J.F.B.).,Departamento de Estructura de la Materia, Física Térmica y Electrónica, Universidad Complutense de Madrid, IdISSC, Spain (A.M.-C., S.E.)
| | - Jesús Mateo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (P.N., C.V., A.M.-C., L.G.-C., R.A.M., S.E., J.M., J.F.B.)
| | - Jacob F Bentzon
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (P.N., C.V., A.M.-C., L.G.-C., R.A.M., S.E., J.M., J.F.B.).,Heart Diseases and Steno Diabetes Center Aarhus, Department of Clinical Medicine, Aarhus University, Denmark (J.F.B.)
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The Usefulness of [ 18F]F-Fluorodeoxyglucose and [ 18F]F-Sodium Fluoride Positron Emission Tomography Imaging in the Assessment of Early-Stage Aortic Valve Degeneration after Transcatheter Aortic Valve Implantation (TAVI)-Protocol Description and Preliminary Results. J Clin Med 2021; 10:jcm10030431. [PMID: 33499425 PMCID: PMC7866182 DOI: 10.3390/jcm10030431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 01/30/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is now a well-established treatment for severe aortic stenosis. As the number of procedures and indications increase, the age of patients decreases. However, their durability and factors accelerating the process of degeneration are not well-known. The aim of the study was to verify the possibility of using [18F]F-sodium fluoride ([18F]F-NaF) and [18F]F-fluorodeoxyglucose ([18F]F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing the intensity of TAVI valve degenerative processes. In 73 TAVI patients, transthoracic echocardiography (TTE) at initial (before TAVI), baseline (after TAVI), and during follow-up, as well as transesophageal echocardiography (TEE) and PET/CT, were performed using [18F]F-NaF and [18F]F-FDG at the six-month follow-up (FU) visit as a part of a two-year FU period. The morphology of TAVI valve leaflets were assessed in TEE, transvalvular gradients and effective orifice area (EOA) in TTE. Calcium scores and PET tracer activity were counted. We assessed the relationship between [18F]F-NaF and [18F]F-FDG PET/CT uptake at the 6 = month FU with selected indices e.g.,: transvalvular gradient, valve type, EOA and insufficiency grade at following time points after the TAVI procedure. We present the preliminary PET/CT ([18F]F-NaF, [18F]F-FDG) results at the six-month follow-up period as are part of an ongoing study, which will last two years FU. We enrolled 73 TAVI patients with the mean age of 82.49 ± 7.11 years. A significant decrease in transvalvular gradient and increase of effective orifice area and left ventricle ejection fraction were observed. At six months, FU valve thrombosis was diagnosed in four patients, while 7.6% of patients refused planned controls due to the COVID-19 pandemic. We noticed significant correlations between valve types, EOA and transaortic valve gradients, as well as [18F]F-NaF and [18F]F-FDG uptake in PET/CT. PET/CT imaging with the use of [18F]F-FDG and [18F]F-NaF is intended to be feasible, and it practically allows the standardized uptake value (SUV) to differentiate the area containing the TAVI leaflets from the SUV directly adjacent to the ring calcifications and the calcified native leaflets. This could become the seed for future detection and evaluation capabilities regarding the progression of even early degenerative lesions to the TAVI valve, expressed as local leaflet inflammation and microcalcifications.
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