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2 Predicting abdominal aortic aneurysm growth using 18F-sodium fluoride PET-CT
  1. Rachael O Forsythe1,2,3,
  2. Marc R Dweck1,2,3,
  3. Olivia MB McBride1,2,3,
  4. Alex T Vesey1,2,
  5. Scott I Semple1,2,
  6. Anoop SV Shah1,2,
  7. Philip Adamson1,2,3,
  8. William Wallace3,
  9. Jakub Kaczynski1,2,3,
  10. Edwin JR van Beek1,2,3,
  11. Calum D Gray1,2,
  12. Alison Fletcher1,2,
  13. Christophe Lucatelli1,2,
  14. Aleksander Marin1,2,
  15. Paul J Burns3,
  16. Andrew L Tambyraja3,
  17. Roderick TA Chalmers3,
  18. Graeme Weir3,
  19. Neil Mitchard3,
  20. Adriana Tavares1,2,
  21. Jennifer MJ Robson1,2,
  22. David E Newby1,2
  1. 1British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  2. 2Edinburgh Imaging Facility, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
  3. 3NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK

Abstract

Introduction Abdominal aortic aneurysm (AAA) growth is non-linear, yet surveillance relies on ultrasound-derived measures of diameter to predict future growth. Biology plays a key part in aneurysm evolution but is not routinely assessed. 18F-Sodium Fluoride (18F-NaF) PET-CT identifies active vascular calcification associated with high-risk atherosclerotic plaque. In patients with AAA, we evaluated the use of 18F-NaF PET-CT to predict aneurysm growth and outcomes.

Methods In prospective case-control (n=20 per group) and longitudinal cohort studies (patients with AAA ≥4 cm, n=72), subjects underwent ultrasound, 18F-NaF PET-CT, CT angiography and calcium scoring. Endpoints were aneurysm expansion and AAA repair or rupture.

Results Higher uptake of 18F-NaF was observed in AAA vs nonaneurysmal aorta within the same subjects (p=0.004) and aortas of control subjects (p=0.023). 18F-NaF uptake localised to areas of aneurysm disease and active calcification on histology and micro-PET-CT. In the cohort study of predominantly elderly (mean age 73) men (85%), there were 19 AAA repairs (26.4%) and 3 ruptures (4.2%) after 510±196 days. Aneurysms in the highest tertile of 18F-NaF uptake expanded 2.5 times more rapidly than those in the lowest tertile (3.10 [IQR 2.34–5.92 mm/yr] vs 1.24 [IQR 0.52 to 2.92 mm/yr]; p=0.008) and were almost 3 times more likely to rupture or be repaired (15.3% vs 5.6%; log-rank p=0.043), even when adjusted for aneurysm diameter. Agatston score was not associated with future growth or clinical events.

Conclusion 18F-NaF uptake is an independent predictor of AAA growth. This is a novel and promising approach to the identification of disease activity in patients with AAA.

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