Atherogenic Indices as a Predictor of Aortic Calcification in Prostate Cancer Patients Assessed Using 18F-Sodium Fluoride PET/CT

Abstract

A major pathophysiological cause of cardiovascular disease is vascular plaque calcification. Fluorine 18–Sodium Fluoride (18F-NaF) PET/CT can be used as a sensitive imaging modality for detection of vascular calcification. The aim of this study was to find a non-invasive, cost-efficient, and readily available metric for predicting vascular calcification severity. This retrospective study was performed on 36 participants who underwent 18F-NaF fused PET/CT scans. The mean standard uptake values (SUVs) were calculated from manually sectioned axial sections over the aortic arch and thoracic aorta. Correlation analyses were performed between SUVs and calculated atherogenic indices (AIs). Castelli’s Risk Index I (r = 0.63, p < 0.0001), Castelli’s Risk Index II (r = 0.64, p < 0.0001), Atherogenic Coefficient (r = 0.63, p < 0.0001), Atherogenic Index of Plasma (r = 0.51, p = 0.00152), and standalone high-density lipoprotein (HDL) cholesterol (r = −0.53, p = 0.000786) were associated with aortic calcification. AIs show strong association with aortic arch and thoracic aorta calcifications. AIs are better predictors of vascular calcification compared to standalone lipid metrics, with the exception of HDL cholesterol. Clinical application of AIs provides a holistic metric beneficial for enhancing screening and treatment protocols.

NaF-PET Imaging of Atherosclerosis Burden

“…Forty-five articles were included in this review [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] ( Figure 1 ), to which were added selected articles on methodological and other aspects. Findings in the articles are summarized in the following sections and in Tables S1–S6 in the Supplementary Material .…”

“…Anti-atherosclerotic intervention evaluated by NaF-PET/CT [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ].…”

“…Several studies dealt with one arterial bed only, i.e., coronary arteries [ 16 , 17 , 18 , 20 , 29 , 30 , 31 , 38 , 39 , 44 ], global heart [ 22 , 23 , 24 , 25 , 27 , 34 ], pulmonary arteries [ 11 ], left carotid artery [ 28 ], aorta [ 26 , 32 , 41 , 42 , 48 , 49 ], abdominal aorta [ 13 , 33 , 45 ], or several arterial beds [ 5 , 6 , 7 , 8 , 9 , 10 , 12 , 14 , 15 , 21 , 35 , 36 , 37 , 40 , 41 , 43 , 46 , 47 ]. Eight reports were experimental animal studies [ 5 , 6 , 32 , 42 , 43 , 45 , 48 , 49 ], and one was an image case report [ 44 <...…”

“…Finally, Dai et al [ 41 ] found in a retrospective analysis of scans performed in 36 men with prostate cancer mainly weak correlations between proximal thoracic aortic NaF uptake and various cardiovascular risk factors, precluding any useful prediction of future vascular events.…”

“…In patients with known CAD, MI occurred only in those with abnormal baseline coronary NaF [ 29 ]; in diabetics, calcification progression was more common among NaF positive than NaF negative coronary arteries [ 30 ], while in patients with multivessel disease there was more rapid progression of CT-calcification among those with increased coronary NaF uptake and an increase in calcium score only in coronary segments with NaF uptake [ 31 ]. In major extracardial arteries of type 2 diabetic patients, there was a strong correlation of baseline FDG with NaF uptake measured at a 5-year follow-up [ 36 ], while in patients with prostate cancer there was weak association of aortic NaF uptake and several liquid atherosclerosis biomarkers, of little clinical impact [ 41 ].…”