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4 18F-sodium fluoride positron emission tomography predicts progression of coronary calcification
  1. Mhairi Doris1,
  2. Alastair Moss1,
  3. Jack Andrews1,
  4. Maaz Syed1,
  5. Rong Bing1,
  6. Michelle Williams2,
  7. Edwin J R van Beek3,
  8. Laura Forsyth1,
  9. Marc Dweck2,
  10. David Newby2,
  11. Philip Adamson4
  1. 1University of Edinburgh
  2. 2University of Edinburgh
  3. 2British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh
  4. 3Edinburgh Imaging facility, Queens Medical Research Institute
  5. 4University of Otago, Christchurch


Introduction Combined positron emission tomography and computed tomography (PET-CT) using the radiotracer 18F-sodium fluoride (18F-NaF) to detect microcalcification provides imaging of both coronary artery anatomy and disease activity simultaneously. While recent studies have suggested that 18F-NaF activity may help identify high-risk coronary atherosclerosis, the role of 18F-NaF uptake in predicting progression of coronary atherosclerosis is unknown. In this study, we aimed to investigate the relationship between baseline coronary arterial 18F-NaF activity and the subsequent progression of coronary arterial calcification in patients with clinically stable coronary artery disease.

Methods Patients with clinically stable, multivessel coronary artery disease underwent combined 18F-NaF PET-CT and CT coronary calcium scoring at baseline with repeat CT coronary calcium scoring at one year. Coronary arterial PET uptake was analysed qualitatively and semi-quantitatively in diseased vessels by measuring maximum tissue-to-background ratio (TBRmax) – defined as the maximum standardised uptake value in a plaque divided by the mean blood pool activity measured in the right atrium. Coronary calcification was quantified by measuring calcium mass (mg), volume (mm3), average calcium density (mg/mm3) and total Agatston score (AU).

Results One hundred and eighty-three patients who underwent baseline and repeat imaging at one year were included in the study (81% male, median age 66). Of these participants, 116 (63%) had evidence of increased 18F-NaF activity in at least one vessel. Patients with increased 18F-NaF uptake had a higher total calcium score (524[242–1091] AU), volume (491[247–984], mm3) mass (99[46–212] mg) and average calcium density (0.20[0.18–0.23] mg/mm3) at baseline compared to patients without increased uptake (136[55–361] AU, 131[54–343] mm3, 24[11–69] mg, 0.18[0.16–0.20] mg/mm3; P<0.001 for all), and demonstrated greater progression of coronary calcification (table 1). In patients with an increase in calcium score at one year (n=160), there was a moderate correlation between baseline TBRmax and change in total calcium score (R=0.45, R2=0.20; p<0.001) and change in total calcium mass (R=0.50, R2=0.25; p<0.001) at one year (figure 1). There was no correlation between baseline TBRmax and change in average calcium density (p=0.43).

Abstract 4 Table 1

Progression of coronary calcification in patients with and without increased 18F-NaF activity at baseline

Conclusion Coronary PET-CT using 18F-NaF identifies patients with a higher calcification burden and predicts progression of coronary arterial calcification at one year.

Conflict of Interest none

  • Positron Emission Tomography
  • Calcification
  • Coronary Atherosclerosis

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