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12 Precision imaging of coronary atherosclerotic microcalcification using 18F-fluoride
  1. Alastair J Moss1,
  2. Philip D Adamson1,
  3. Mhairi K Doris1,
  4. Jack Andrews1,
  5. Alisia Sim1,
  6. Edwin JR van Beek2,
  7. Laura Forsyth3,
  8. Robert Lee4,
  9. Steff Lewis4,
  10. Adriana Tarvares1,
  11. Marc R Dweck1,
  12. David E Newby1
  1. 1BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  2. 2Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
  3. 3Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
  4. 4Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK


Introduction 18F-Fluoride is a highly sensitive positron emission tomography tracer that binds to microcalcification. When combined with computed tomography angiography (PET-CT), it enables simultaneous anatomical and metabolic imaging that non-invasively identifies high-risk plaques in coronary arteries. Uncertainty persists regarding the optimal parameter to quantify metabolic activity in coronary arteries and reliably discriminate 18F-fluoride from the surrounding myocardium. This prospective clinical study evaluates the precision of 18F-fluoride quantification.

Methods Thirty patients with multi-vessel coronary artery disease underwent serial 18F-fluoride coronary PET-CT within 2 weeks. Coronary 18F-fluoride maximum activity (SUVMAX) was referenced to left atrial activity (TBRMAX) to evaluate the accuracy of repeated measures. Coefficient of variance of 18F-fluoride was calculated to establish a threshold of precision measurement.

Results Twenty patients with stable coronary artery disease and ten patients with recent acute coronary syndrome. All coronary artery segments (n=171) were measured in sextuplicate with diagnostic precision of 18F-fluoride activity (coefficient of variation <15%) at values of TBRMAX >0.9. A single plaque TBRMAX >0.9 was present in 90% (n=9/10) of acute coronary syndrome patients and 60% (n=12/20) of stable coronary artery disease patients. On a per-patient level, the overall agreement for visual assessment of 18F-fluoride uptake was good (κ=0.64) and was significantly improved with the application of a quantitative threshold (κ=0.84).

Conclusion 18F-fluoride PET-CT provides a precise measurement of calcification activity in the coronary vasculature. These assessment techniques will support prospective trials of this radiotracer as a non-invasive imaging biomarker of plaque vulnerability.

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