Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-07-2020 | Computed Tomography | Original Article

Whole-vessel coronary ¹⁸F-sodium fluoride PET for assessment of the global coronary microcalcification burden

Authors: Jacek Kwiecinski, Sebastien Cadet, Marwa Daghem, Martin L. Lassen, Damini Dey, Marc R. Dweck, Daniel S. Berman, David E. Newby, Piotr J. Slomka

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 7/2020

Abstract

Purpose

¹⁸F-sodium fluoride (¹⁸F-NaF) has shown promise in assessing disease activity in coronary arteries, but currently used measures of activity – such as maximum target to background ratio (TBRmax) – are defined by single pixel count values. We aimed to develop a novel coronary-specific measure of ¹⁸F-NaF PET reflecting activity throughout the entire coronary vasculature (coronary microcalcification activity [CMA]).

Methods

Patients with recent myocardial infarction and multi-vessel coronary artery disease underwent ¹⁸F-NaF PET and coronary CT angiography. We assessed the association between coronary ¹⁸F-NaF uptake (both TBRmax and CMA) and coronary artery calcium scores (CACS) as well as low attenuation plaque (LAP, attenuation < 30 Hounsfield units) volume.

Results

In 50 patients (64% males, 63 ± 7 years), CMA and TBRmax were higher in vessels with LAP compared to those without LAP (1.09 [0.02, 2.34] versus 0.0 [0.0, 0.0], p < 0.001 and 1.23 [1.16, 1.37] versus 1.04 [0.93, 1.11], p < 0.001). Compared to a TBRmax threshold of 1.25, CMA > 0 had a higher diagnostic accuracy for detection of LAP: sensitivity of 93.1 (83.3–98.1)% versus 58.6 (44.9–71.4)% and a specificity of 95.7 (88.0–99.1)% versus 80.0 (68.7–88.6)% (both p < 0.001).

¹⁸F-NaF uptake assessed by CMA correlated more closely with LAP (r = 0.86, p < 0.001) than the CT calcium score (r = 0.39, p < 0.001), with these associations outperforming those observed for TBRmax values (LAP r = 0.63, p < 0.001; CT calcium score r = 0.30, p < 0.001).

Conclusions

Automated assessment of disease activity across the entire coronary vasculature is feasible using ¹⁸F-NaF CMA, providing a single measurement that has closer agreement with CT markers of plaque vulnerability than more traditional measures of plaque activity.

Available only for authorised users

Go AS, Mozaffarian D, Roger VL, for theAmerican Heart Association Statistics Committee and Stroke Statistics Subcommittee, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–e292.CrossRef

Arbab-Zadeh A, Fuster V. The Myth of the “Vulnerable Plaque”. J Am Coll Cardiol. 2015;65(8):846–55. https://doi.org/10.1016/j.jacc.2014.11.041.CrossRefPubMedPubMedCentral

Dweck MR, Aikawa E, Newby DE, Tarkin JM, Rudd JH, Narula J, et al. Noninvasive molecular imaging of disease activity in atherosclerosis. Circ Res. 2016;119:330–40. https://doi.org/10.1161/CIRCRESAHA.116.307971.CrossRefPubMedPubMedCentral

Stone GW, Maehara A, Lansky AJ, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011;364:226–35. https://doi.org/10.1056/NEJMoa1002358.CrossRefPubMed

Calvert PA, Obaid DR, O’Sullivan M, et al. Association between IVUS findings and adverse outcomes in patients with coronary artery disease: the VIVA (VH-IVUS in vulnerable atherosclerosis) study. JACC Cardiovasc Imaging. 2011;4:894–901. https://doi.org/10.1016/j.jcmg.2011.05.005.CrossRefPubMed

Williams MC, Moss AJ, Dweck M, et al. Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-HEART study. J Am Coll Cardiol. 2019;73:291–301.CrossRef

Ferencik M, Mayrhofer T, Bittner DO, et al. Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: a secondary analysis of the PROMISE randomized clinical trial. JAMA Cardiol. 2018;3:144–52.CrossRef

Nerlekar N, Ha FJ, Cheshire C, Rashid H, et al. Computed tomographic coronary angiography–derived plaque characteristics predict major adverse cardiovascular events: a systematic review and meta-analysis. Circ Cardiovasc Imaging. 2018;10:e006973. https://doi.org/10.1161/CIRCIMAGING.117.006973.CrossRef

Rudd JHF, Warburton EA, Fryer TD, et al. Imaging atherosclerotic plaque inflammation with F-18 -fluorodeoxyglucose positron emission tomography. Circulation. 105(23):2708–11. https://doi.org/10.1161/01.cir.0000020548.60110.76.CrossRef

10.

Tarkin JM, Joshi FR, Evans NR, et al. Detection of Atherosclerotic Inflammation by (68)Ga-DOTATATE PET Compared to [(18)F]FDG PET Imaging. J Am Coll Cardiol. 69(14):1774–91. https://doi.org/10.1016/j.jacc.2017.01.060.CrossRef

11.

Joshi NV, Vesey AT, Williams MC, et al. F-18-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial. Lancet. 383(9918):705–13. https://doi.org/10.1016/s0140-6736(13)61754-7.CrossRef

12.

Bellinge JW, Francis RJ, Majeed K, et al. In search of the vulnerable patient or the vulnerable plaque: (18)F-sodium fluoride positron emission tomography for cardiovascular risk stratification. J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-1360-2.CrossRef

13.

Beheshti M, Saboury B, Mehta N. Detection and global quantification of cardiovascular molecular calcification by fluoro-18-fluoride positron emission tomography/computed tomography—a novel concept. Hell J Nucl Med. 2011;14:114–20.PubMed

14.

Blomberg BA, Thomassen A, de Jong PA, et al. Impact of personal characteristics and technical factors on quantification of sodium 18F-fluoride uptake in human arteries: prospective evaluation of healthy subjects. J Nucl Med. 2015;56:1534–40.CrossRef

15.

Kwiecinski J, Adamson PD, Lassen ML, et al. Feasibility of coronary 18F-sodium fluoride PET assessment with the utilization of previously acquired CT angiography. Circ Cardiovasc Imaging. 2018;11(12):e008325.CrossRef

16.

Leipsic J, Abbara S, Achenbach S, Cury R, Earls JP, Mancini GJ, et al. SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. JCCT. 2014;8:342–58.

17.

Rubeaux M, Joshi N, Dweck MR, et al. Motion correction of 18F-sodium fluoride PET for imaging coronary atherosclerotic plaques. J Nucl Med Soc Nuclear Med. 2015. https://doi.org/10.2967/jnumed.115.162990.CrossRef

18.

Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.CrossRef

19.

Hell MM, Motwani M, Otaki Y, et al. Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up. Eur Heart J Cardiovasc Imaging. 2017;18:1331–9.CrossRef

20.

Massera D, Doris MK, Cadet S, et al. Analytical quantification of aortic valve 18F-sodium fluoride PET uptake. J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-01542-6.

21.

Doris MK, Otaki Y, Krishnan SK, Kwiecinski J, Rubeaux M, Alessio A et al. Optimization of reconstruction and quantification of motion-corrected coronary PET-CT. J Nucl Cardiol 2018.

22.

Rahim MK, Kim SE, So H, et al. Recent Trends in PET Image Interpretations Using Volumetric and Texture-based Quantification Methods in Nuclear Oncology. Nucl Med Mol Imaging. 48(1):1–15. https://doi.org/10.1007/s13139-013-0260-2.CrossRef

23.

Steven ML, Yusuf E, Timothy A, et al. Tumor Treatment Response Based on Visual and Quantitative Changes in Global Tumor Glycolysis Using PET-FDG Imaging: The Visual Response Score and the Change in Total Lesion Glycolysis. Clin Positron Imaging. 2(3):159–71.

24.

Ahmadian A, Brogan A, Berman J, et al. Quantitative interpretation of FDG PET/CT with myocardial perfusion imaging increases diagnostic information in the evaluation of cardiac sarcoidosis. J Nucl Cardiol. 2014;21:925–39. https://doi.org/10.1007/s12350-014-9901-9.CrossRefPubMed

25.

Kwiecinski J, Dey D, Cadet S, et al. Predictors of 18F-sodium fluoride uptake in patients with stable coronary artery disease and adverse plaque features on computed tomography angiography. Eur Heart J Cardiovasc Imaging. 2019. https://doi.org/10.1093/ehjci/jez152.CrossRef

26.

Forsythe RO, Dweck MR, McBride OMB, et al. F-18-Sodium Fluoride Uptake in Abdominal Aortic Aneurysms The SoFIA(3) Study. J Am Coll Cardiol. 71(5):513–23. https://doi.org/10.1016/j.jacc.2017.11.053.CrossRef

27.

Han JH, Lim SY, Lee MS, et al. Sodium [18F]fluoride PET/CT in myocardial infarction. Mol Imaging Biol. 2015;17:214–21.CrossRef

28.

Giovanna Trivieri M, Dweck MR, Abgral R, Robson PM, et al. 18F-sodium fluoride PET/MR for the assessment of cardiac amyloidosis. J Am Coll Cardiol. 2016;68:2712–4.CrossRef

29.

Marchesseau S, Seneviratna A, Sjoholm AT, et al. Hybrid PET/CT and PET/MRI imaging of vulnerable coronary plaque and myocardial scar tissue in acute myocardial infarction. J Nucl Cardiol. 2017.

30.

Chen HHW, Chiu N-T. Su W-Cet al. Prognostic value of whole-body total lesion glycolysis at pretreatment FDG PET/CT in non–small cell lung cancer. Radiology. 2012;264(2):559–66.CrossRef

31.

Frings V, van Velden FHP, Velasquez LM, et al. Repeatability of metabolically active tumor volume measurements with FDG PET / CT in advanced gastrointestinal malignancies: a multicenter study. Radiology. 2014;273(2):539–48.CrossRef

32.

Kramer GM, Frings V, Hoetjes N, et al. Repeatability of quantitative whole-body 18F-FDG PET/CT uptake measures as function of uptake interval and lesion selection in non-small cell lung cancer patients. J Nucl Med. 2016;57(9):1343–9.CrossRef

33.

Lee P, Weerasuriya DK, Lavori PW, et al. Metabolic tumor burden predicts for disease progression and death in lung cancer. Int J Radiat Oncol Biol Phys. 2007;69(2):328–33.CrossRef

34.

La TH, Filion EJ, Turnbull BB, et al. Metabolic tumor volume predicts for recurrence and death in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2009;74(5):1335–41.CrossRef

35.

Kwiecinski J, Berman DS, Lee SE et al. 2018 Three-hour delayed imaging improves assessment of coronary 18F-sodium fluoride PET. J Nucl Me jnumed.118.217885 published ahead of print September 13.

Title: Whole-vessel coronary 18F-sodium fluoride PET for assessment of the global coronary microcalcification burden
Authors: Jacek Kwiecinski
Sebastien Cadet
Marwa Daghem
Martin L. Lassen
Damini Dey
Marc R. Dweck
Daniel S. Berman
David E. Newby
Piotr J. Slomka
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
CT Angiography
Arterial Diseases
Positron Emission Tomography
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 7/2020
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-019-04667-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Whole-vessel coronary ¹⁸F-sodium fluoride PET for assessment of the global coronary microcalcification burden

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2020

No time like the present: time to re-think our habits in science and continuous medical education?

Detailed visualization of the right and left ventricular, left atrial, and epicardial involvement of cardiac sarcoidosis with novel semiconductor PET/CT

Relationship between coronary arterial 18F-sodium fluoride uptake and epicardial adipose tissue analyzed using computed tomography

Facing a disruptive threat: how can a nuclear medicine service be prepared for the coronavirus outbreak 2020?

Reliable quantification of myocardial sympathetic innervation and regional denervation using [11C]meta-hydroxyephedrine PET

Early effects of transcatheter aortic valve replacement on cardiac sympathetic nervous function assessed by 123I-metaiodobenzylguanidine scintigraphy in patients with severe aortic valve stenosis