[18F]FDG and [18F]NaF as PET markers of systemic atherosclerosis progression: A longitudinal descriptive imaging study in patients with type 2 diabetes mellitus

Abstract

Background While [18F]-fluordeoxyglucose ([18F]FDG) uptake is associated with arterial inflammation, [18F]-sodium fluoride ([18F]NaF) is a marker for arterial micro-calcification. We aimed to investigate the prospective correlation between both PET markers over time and whether they are prospectively ([18F]FDG) and retrospectively ([18F]NaF) related to progression of systemic arterial disease in a longitudinal study in patients with type 2 diabetes mellitus (T2DM). Methods Baseline [18F]FDG PET/Low Dose (LD) Computed Tomography (CT) scans of ten patients with early T2DM without cardiovascular history (70% men, median age 63 years) were compared with five-year follow-up [18F]NaF/LDCT scans. Systemic activity was expressed as mean target-to-background ratio (meanTBR) by dividing the maximal standardized uptake value (SUVmax) of ten arteries by SUVmean of the caval vein. CT-assessed macro-calcifications were scored visually and expressed as calcified plaque (CP) score. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (PWV). Five-year changes were expressed absolutely with delta (Δ) and relatively with %change. Results Baseline meanTBR[18F]FDG was strongly correlated with five-year follow-up meanTBR[18F]NaF (r = 0.709, P = .022). meanTBR[18F]NaF correlated positively with ΔCPscore, CPscore at baseline, and follow-up (r = 0.845, P = .002 and r = 0.855, P = .002, respectively), but not with %change in CPscore and PWV. Conclusion This proof-of-concept study demonstrated that systemic arterial inflammation is an important pathogenetic factor in systemic arterial micro-calcification development.

Acute and Long-Term Consequences of COVID-19 on Arterial Stiffness—A Narrative Review

“…Computer tomography (CT) and fluorodeoxyglucose (FDG)-positron emission tomography (FDG-PET) have also been previously used for estimation of both arterial stiffness and cardiovascular risk. Although FDG-PET provides valuable insight regarding subclinical arterial inflammation and is associated with PWV [ 47 , 48 ], it has several limitations: limited availability, high costs and a somewhat high radiation exposure. Meanwhile, CT is broadly available, rather cheap and frequently used in the assessment of COVID-19 patients.…”

Atherosclerosis Burdens in Diabetes Mellitus: Assessment by PET Imaging

“…Below (and in Supplementary Material, Tables S1–S5 ) the literature is summarized according to five categories: Inflammation mechanisms and targeting (FDG only, see below) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], Early detection and prevalence of arterial FDG or NaF uptake [ 30 , 31 , 32 , 33 , 34 , 35 ], Cardiovascular risk in DM [ 36 , 37 , 38 ], Disease progression [ 39 , 40 ], Therapy [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. …”

“…Seven studies dealt with the carotids [ 22 , 24 , 25 , 28 , 31 , 33 , 37 ], five with the coronary arteries [ 26 , 35 , 40 , 42 , 45 ], three with the aorta [ 23 , 29 , 44 ], and three with the femoral arteries [ 32 , 38 , 43 ]. Three studies focused on the carotids and the aorta [ 41 , 46 , 49 ], two on the coronary arteries and the thoracic aorta [ 47 , 48 ], and five on several major arteries [ 27 , 30 , 34 , 36 , 39 ]. Four were animal experiments [ 23 , 26 , 29 , 44 ].…”

Molecular Imaging of Lower Extremity Peripheral Arterial Disease: An Emerging Field in Nuclear Medicine

“…Other additional applications of 18 F-NaF in the setting of PAD over the past 2 years have demonstrated the feasibility of using 18 F-NaF PET/CT imaging to evaluate active microcalcification of occlusive lower extremity aneurysms (44), quantify the inflammatory response to lower extremity balloon angioplasty and predict risk for vascular restenosis after peripheral interventions (45), and evaluate the role of arterial inflammation in promoting systemic vascular calcification (46). Thus, the applications for 18 F-NaF PET/CT are rapidly evolving, with numerous future research directions on the horizon for molecular imaging of atherosclerosis in patients with PAD.…”