18F-NaF and 18F-FDG as molecular probes in the evaluation of atherosclerosis

Abstract

The early detection of atherosclerotic disease is vital to the effective prevention and management of life-threatening cardiovascular events such as myocardial infarctions and cerebrovascular accidents. Given the potential for positron emission tomography (PET) to visualize atherosclerosis earlier in the disease process than anatomic imaging modalities such as computed tomography (CT), this application of PET imaging has been the focus of intense scientific inquiry. Although 18F-FDG has historically been the most widely studied PET radiotracer in this domain, there is a growing body of evidence that 18F-NaF holds significant diagnostic and prognostic value as well. In this article, we review the existing literature on the application of 18F-FDG and 18F-NaF as PET probes in atherosclerosis and present the findings of original animal and human studies that have examined how well 18F-NaF uptake correlates with vascular calcification and cardiovascular risk.

Atherosclerosis imaging with 18F-sodium fluoride PET: state-of-the-art review

“…6) [23,30,36]. Studies in a metabolic syndrome pig model suggest that increased coronary uptake of NaF is present in the very early-stages of atherosclerosis since fatty coronary streaks of these swine pick up NaF [45]. Pathologic studies have demonstrated that almost every North American child over the age of 3 years has some degree of aortic fatty streaks [46] and that by the age of 15-19 years, fatty streaks occupy about 25% of the aortic intima in the thoracic and abdominal aorta and that they increase in the abdominal aorta to occupy nearly 40% at the age of 34-40 years [47].…”

18F-sodium fluoride: An old tracer with a new promising clinical application

“…6 Therefore, the early and effective detection, particularly of plaques vulnerable to rupture, of atherosclerotic disease is vital to the effective prevention and management of life-threatening cardiovascular events such as myocardial infarctions and cerebrovascular accidents. 7 Assessment of Framingham risk factors such as dyslipidemia, hypertension, and diabetes can identify patients at risk of developing atherosclerotic disease but cannot clarify the extent or vulnerability of existing plaques. Clinical evaluations performed in symptomatic patients, such as the ankle-brachial index and cardiac stress tests, are useful to investigate the presence of intraluminal stenosis, but the degree of stenosis alone has not been shown to be predictive of plaque rupture.…”

“…Conventional ultrasonography and angiography techniques can be used to examine the extent of luminal stenosis, while cardiac computed tomography (CT) can be used to obtain calcium scores to quantify the calcification of the coronary vessels. 7 Yet, other modalities, including multidetector CT coronary angiography, magnetic resonance imaging, intravascular ultrasonography, and optical coherence tomography, have begun to be implemented with the specific aim of determining plaque composition. 10,11 The plaque composition most strongly associated with rupture includes a thin fibrous cap, a lipid-rich necrotic core, neovascularization, intraplaque hemorrhage, and microcalcifications.…”

“…By contrast, 18 F-sodium fluoride (NaF) is a specific marker of bone mineralization that has traditionally been used in diagnosing metastatic bone cancer but has recently been applied to vascular calcification. 7 Reprint requests: Valeria Cantoni, PhD, Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy; valeria.cantoni@unina.it J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2019 American Society of Nuclear Cardiology. F-NaF has also shown considerable promise in allowing the evaluation of patients at risk of atherosclerosis.…”

The good rays: let them shine!

“…X-rays and radioactivity were discovered more than 120 years ago, and yet their potential in medical imaging has still not been fully exploited while the cost of healthcare is on a steep rise and more individualized diagnostics and therapy are called for. An example of this is PET imaging with 18 F-NaF to detect and grade early arterial wall microcalcification when it may still be amenable to therapy [21]. NaF imaging is a methodology that may potentially lead to a breakthrough in the management of atherosclerosis, the world’s number one killing disease [22], which may afflict us all if we grow old enough.…”