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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-11-2018 | Original Article

Sodium-fluoride PET-CT for the non-invasive evaluation of coronary plaques in symptomatic patients with coronary artery disease: a cross-correlation study with intravascular ultrasound

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

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 12/2018

Abstract

Objectives

The aim of this study was to evaluate the ¹⁸F-sodium fluoride (¹⁸F-NaF) coronary uptake compared to coronary intravascular ultrasound (IVUS) in patients with symptomatic coronary artery disease.

Background

¹⁸F-NaF PET enables the assessment of vascular osteogenesis by interaction with surface hydroxyapatite, while IVUS enables both identification and quantification of intra-plaque components.

Methods

Forty-four patients with symptomatic coronary artery disease were included in this prospective controlled trial, 32 of them (30 patients with unstable angina and 2 patients with stable angina), representing the final study cohort, got additional IVUS. All patients underwent cardiac ¹⁸F-NaF PET/CT and IVUS within 2 days. ¹⁸F-NaF maximum tissue-to-blood ratios (TBR_max) were calculated for 69 coronary plaques and correlated with IVUS plaque classification.

Results

Significantly increased ¹⁸F-NaF uptake ratios were observed in fibrocalcific lesions (meanTBR_max = 1.42 ± 0.28), thin-cap atheroma with spotty calcifications (meanTBR_max = 1.32 ± 0.23), and thick-cap mixed atheroma (meanTBR_max = 1.28 ± 0.38), while fibrotic plaques showed no increased uptake (meanTBR_max = 0.96 ± 0.18). The ¹⁸F-NaF uptake ratio was consistently higher in atherosclerotic lesions with severe calcification (meanTBR_max = 1.34 ± 0.22). The regional ¹⁸F-NaF uptake was most likely localized in the border region of intensive calcification. Coronary lesions with positive ¹⁸F-NaF uptake showed some increased high-risk anatomical features on IVUS in comparison to ¹⁸F-NaF negative plaques. It included a significant severe plaque burden (70.1 ± 13.8 vs. 61.0 ± 13.8, p = 0.01) and positive remodeling index (1.03 ± 0.08 vs. 0.99 ± 0.07, p = 0.05), as well as a higher percentage of necrotic tissue (37.6 ± 13.3 vs. 29.3 ± 15.7, p = 0.02) in positive ¹⁸F-NaF lesions.

Conclusions

¹⁸F-NaF coronary uptake may provide a molecular insight for the characterization of coronary atherosclerotic lesions. Specific regional uptake is needed to be determined by histology.

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Title: Sodium-fluoride PET-CT for the non-invasive evaluation of coronary plaques in symptomatic patients with coronary artery disease: a cross-correlation study with intravascular ultrasound
Authors: Li Li
Xiang Li
Yongping Jia
Jiamao Fan
Huifeng Wang
Chunyu Fan
Lei Wu
Xincheng Si
Xinzhong Hao
Ping Wu
Min Yan
Ruonan Wang
Guang Hu
Jianzhong Liu
Zhifang Wu
Marcus Hacker
Sijin Li
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 12/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-018-4122-0

At a glance: The STEP trials

Springer Medicine

Sodium-fluoride PET-CT for the non-invasive evaluation of coronary plaques in symptomatic patients with coronary artery disease: a cross-correlation study with intravascular ultrasound

Abstract

Objectives

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Background

Methods

Results

Conclusions

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