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

Abstract

Purpose We examined the literature to elucidate the role of 18F-sodium fluoride (NaF)-PET in atherosclerosis. Methods Following a systematic search of PubMed/MEDLINE, Embase, and Cochrane Library included articles underwent subjective quality assessment with categories low, medium, and high. Of 2811 records, 1780 remained after removal of duplicates. Screening by title and abstract left 41 potentially eligible full-text articles, of which 8 (about the aortic valve (n = 1), PET/ MRI feasibility (n = 1), aortic aneurysms (n = 1), or quantification methodology (n = 5)) were dismissed, leaving 33 published 2010-2012 (n = 6), 2013-2015 (n = 11), and 2016-2018 (n = 16) for analysis. Results They focused on coronary (n = 8), carotid (n = 7), and femoral arteries (n = 1), thoracic aorta (n = 1), and infrarenal aorta (n = 1). The remaining 15 studies examined more than one arterial segment. The literature was heterogeneous: few studies were designed to investigate atherosclerosis, 13 were retrospective, 9 applied both FDG and NaF as tracers, 24 NaF only. Subjective quality was low in one, medium in 13, and high in 19 studies. The literature indicates that NaF is a very specific tracer that mimics active arterial wall microcalcification, which is positively associated with cardiovascular risk. Arterial NaF uptake often presents before CT-calcification, tends to decrease with increasing density of CT-calcification, and appears, rather than FDG-avid foci, to progress to CT-calcification. It is mainly surface localized, increases with age with a wide scatter but without an obvious sex difference. NaF-avid microcalcification can occur in fatty streaks, but the degree of progression to CT-calcification is unknown. It remains unknown whether medical therapy influences microcalcification. The literature held no therapeutic or randomized controlled trials. Conclusion The literature was heterogeneous and with few clear cut messages. NaF-PET is a new approach to detect and quantify microcalcification in early-stage atherosclerosis. NaF uptake correlates with cardiovascular risk factors and appears to be a good measure of the body's atherosclerotic burden, potentially suited also for assessment of anti-atherosclerotic therapy.

Atherosclerosis Imaging with 18F-Sodium Fluoride PET

“…Using the same principles as previously described [ 1 ] including the Patient, Intervention, Comparison, Outcome Study (PICOS) approach [ 2 ], we searched PubMed/MEDLINE, Embase, and the Cochrane Library to extract relevant peer-reviewed articles on NaF-PET imaging in atherosclerosis published in English from 1 January 2019 and until 31 March 2020. We focused on (a) patients with any disease and (b) diagnostic performance, lesion detection, qualitative evaluation, and feasibility in (c) studies on evaluation of atherosclerosis.…”

“…A previous review of the literature on atherosclerosis imaging with 18 F-sodium-fluoride (NaF) positron emission tomography (PET) published 2010–2018 left us with some major questions unanswered: (1) to what extent and with what consistency is arterial wall NaF uptake followed by or translated into CT-detectable calcification, (2) in which compartment of the arterial wall does the NaF-detectable microcalcification first occur, and (3) can NaF-avid microcalcification be diminished or abolished by medical therapy or other types of intervention [ 1 ]. To present the current state of the art, we have surveyed the most recent literature to examine if these important questions have been elucidated.…”

Beneficial Effects of Melatonin on Apolipoprotein-E Knockout Mice by Morphological and 18F-FDG PET/CT Assessments

“…According to the findings of Høilund-Carlsen et al and our considerations, it is important that innovation in diagnostics supports renewal therapies [19].…”

“…It has been identified as a potential new "gold standard" approach for studying early-stage atherosclerosis considering its non-invasiveness. In fact, this technique allows an early grading of the disease when it may still be susceptible to therapy [19]. Furthermore, 18 F-FDG is considered as a good indicator of aerobic glycolysis in tumor tissue [23].…”

Potential of PET/CT in assessing dementias with emphasis on cerebrovascular disorders

“…In contrast, fused PET/CT imaging has demonstrated potential early diagnosis of atherosclerosis. While FDG-PET/CT is a powerful tool to assess brain function and inflammation, it has become increasingly apparent that 18 F-sodium fluoride (NaF) is both a sensitive and specific tracer for the early diagnosis of atherosclerosis [36]. FDG-PET/ CT has been used to detect vascular inflammatory processes with variable success [37,38].…”