Identifying active vascular microcalcification by (18)F-sodium fluoride positron emission tomography

Area of Science:

• Cardiovascular Research
• Medical Imaging
• Biomedical Engineering

Background:

• Vascular calcification is a critical component of atherosclerosis, influencing plaque stability and patient outcomes.
• Microcalcification within atherosclerotic plaques signifies high-risk, unstable atheroma associated with increased morbidity and mortality.
• Current imaging modalities struggle to non-invasively identify pathological microcalcification.

Purpose of the Study:

• To elucidate the molecular mechanism of (18)F-sodium fluoride ((18)F-NaF) vascular uptake in atherosclerosis.
• To evaluate the potential of (18)F-NaF Positron Emission Tomography/Computed Tomography (PET/CT) for identifying nascent microcalcification.
• To differentiate between macro- and microcalcification using (18)F-NaF PET/CT.

Main Methods:

• Utilized electron microscopy, autoradiography, histology, and preclinical/clinical PET/CT imaging.
• Analyzed (18)F-NaF binding characteristics within atherosclerotic plaques.
• Correlated imaging findings with histological and ultrastructural assessments.

Main Results:

• Demonstrated high-affinity, selective, and specific adsorption of (18)F-NaF to calcified deposits.
• (18)F-NaF PET/CT successfully distinguished between areas of macro- and microcalcification.
• Identified (18)F-NaF PET/CT as the sole non-invasive clinical imaging platform for detecting microcalcification in unstable atherosclerosis.

Conclusions:

• (18)F-NaF exhibits specific binding to calcified atherosclerotic lesions, enabling differentiation of micro- and macrocalcification.
• (18)F-NaF PET/CT offers a unique non-invasive method for visualizing high-risk microcalcifications in unstable atheroma.
• This imaging technique holds promise for advancing the development of targeted therapies for vascular calcification.