RT Journal Article SR Electronic T1 2 Predicting abdominal aortic aneurysm growth using 18F-sodium fluoride PET-CT JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP A1 OP A1 DO 10.1136/heartjnl-2018-BCVI.2 VO 104 IS Suppl 5 A1 Rachael O Forsythe A1 Marc R Dweck A1 Olivia MB McBride A1 Alex T Vesey A1 Scott I Semple A1 Anoop SV Shah A1 Philip Adamson A1 William Wallace A1 Jakub Kaczynski A1 Edwin JR van Beek A1 Calum D Gray A1 Alison Fletcher A1 Christophe Lucatelli A1 Aleksander Marin A1 Paul J Burns A1 Andrew L Tambyraja A1 Roderick TA Chalmers A1 Graeme Weir A1 Neil Mitchard A1 Adriana Tavares A1 Jennifer MJ Robson A1 David E Newby YR 2018 UL http://heart.bmj.com/content/104/Suppl_5/A1.2.abstract AB 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.