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117 Optimisation and Reproducibility of 18F-Fluoride Positron Emission Tomography and Computed Tomography in Patients with Aortic Stenosis
  1. Tania Pawade,
  2. Timothy Cartlidge,
  3. David Newby,
  4. Dweck Marc
  1. University of Edinburgh

Abstract

Background 18F-Fluoride positron emission tomography (PET) and computed tomography (CT) can measure disease activity and progression in aortic stenosis. We aimed to optimise imaging methodology, analysis and scan-rescan reproducibility.

Methods Fifteen patients with aortic stenosis underwent 18F-fluoride PET-CT twice within 1 month. We compared non-gated PET and non-contrast CT, with a modified approach that incorporated contrast CT and ECG-gated PET. We explored a range of image analysis techniques including estimation of blood pool activity at differing vascular sites and a most-diseased segment (MDS) approach.

Results Contrast-enhanced ECG-gated PET-CT provided superior spatial localisation of 18F-fluoride uptake that permitted localisation to individual valve leaflets (Figure). Scan-rescan reproducibility was markedly improved using enhanced analysis techniques leading to a reduction in variability from 25% to <10% (tissue-to-background MDS: mean value 1.55, difference 0.05, limits of agreement -0·10 to 0·20).

Abstract 117 Figure 1

Blood pool correction was performed by sampling from the right atrium instedad of the brachio-cephalic vein. 2. The most diseased segment method was used to quantify the PET signal within 2 hottest slices rather than the whole valve/ 3. Contrase CT fused with ECG-gated PET gacilitated better localization to leaflets compared to the original approach 4. Bland-Altmanplots emonstrated superior sacn-rescan reproducibility for the modified technique (2b) compared to the previous approach (2a)

Conclusion Optimised 18F-fluoride PET-CT provides excellent spatial resolution and scan-rescan reproducibility. It holds major promise as a marker of disease activity in aortic stenosis and has major potential as a biomarker end-point of trials of novel therapies in aortic stenosis.

  • Aortic Stenosis
  • 18F-Fluoride Positron Emission Tomography
  • Computed Tomography

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